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1

Phase II Study of Chemoradiotherapy With 5-Fluorouracil and Cisplatin for Stage II-III Esophageal Squamous Cell Carcinoma: JCOG Trial (JCOG 9906)  

SciTech Connect

Purpose: In this Phase II study, we evaluated the efficacy and toxicity of chemoradiotherapy (CRT) with cisplatin (CDDP) and 5-fluorouracil (5-FU) for Stage II-III esophageal squamous cell carcinoma (ESCC). Patients and Methods: Patients with clinical Stage II-III (T1N1M0 or T2-3N0-1M0) thoracic ESCC were enrolled between April 2000 and March 2002. Chemotherapy comprised two courses of protracted infusion of 5-FU (400 mg/m{sup 2}/day) on Days 1-5 and 8-12, and 2-h infusion of CDDP (40 mg/m{sup 2}) on Days 1 and 8; this regimen was repeated every 5 weeks. Concurrent radiotherapy involved 60-Gy irradiation (30 fractions) for 8 weeks with a 2-week break. Responders received two courses of 5-FU (800 mg/m{sup 2}/day) on Days 1-5 and CDDP (80 mg/m{sup 2}) on Day 1. Final analysis was conducted in March 2007. Survival and late toxicities were monitored for 5 years. Results: The characteristics of the 76 patients enrolled were as follows: median age, 61 years; male/female, 68/8; performance status 0/1, 59/17 patients; Stage IIA/IIB/III, 26/12/38 patients. Of the 74 eligible patients, 46 (62.2%) achieved complete response. Median survival time was 29 months, with 3- and 5-year survival rates of 44.7% and 36.8%, respectively. Acute toxicities included Grade 3/4 esophagitis (17%), nausea (17%), hyponatremia (16%), and infection without neutropenia (12%). Late toxicities comprised Grade 3/4 esophagitis (13%), pericardial (16%) and pleural (9%) effusion, and radiation pneumonitis (4%), causing 4 deaths. Conclusions: CRT is effective for Stage II-III ESCC with manageable acute toxicities and can provide a nonsurgical treatment option. However, further improvement is required for reduction in late toxicity.

Kato, Ken, E-mail: kenkato@ncc.go.jp [Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo (Japan); Muro, Kei [Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo (Japan); Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi (Japan); Minashi, Keiko; Ohtsu, Atsushi [Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba (Japan); Ishikura, Satoshi [Clinical Trials and Practice Support Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo (Japan); Boku, Narikazu [Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka (Japan); Takiuchi, Hiroya [Cancer Chemotherapy Center, Osaka Medical College Hospital, Takatsuki, Osaka (Japan); Komatsu, Yoshito [Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Hokkaido (Japan); Miyata, Yoshinori [Department of Internal Medicine, Saku Central Hospital, Nagano (Japan); Fukuda, Haruhiko [Clinical Trials and Practice Support Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo (Japan)

2011-11-01

2

Management of stage II/III rectal cancer  

PubMed Central

Pelvic and distant recurrences in rectal cancer can be associated with substantial morbidity, and patients with stage II and III disease are at increased risk for both local and distant failure when compared to patients with earlier stage disease. Refinement of surgical techniques have helped to reduce the risk of recurrence, and adjuvant therapies such as radiation to the tumor and regional lymph nodes and 5-fluorouracil-based systemic therapies have helped to further provide local control and may have an impact on overall survival. Numerous studies have been completed internationally in an effort to determine the optimal treatment regimen for this patient population. The importance of pre-therapy staging is of key importance as sequencing of therapy appears to significantly impact outcome. In the United States, patients with stage II/III rectal cancer are recommended to undergo preoperative concurrent pelvic radiation and chemotherapy followed by surgery several weeks later in order to maximize treatment response, which is then followed by approximately 4 months of adjuvant 5-fluorouracil-based systemic therapy. In Europe, there is substantial evidence supporting the use of neoadjuvant radiation therapy, however the role of concurrent chemotherapy remains a question of debate. Regardless of definitive management strategy, close follow-up in the post-treatment setting is important for early tumor detection and for managing treatment-related side-effects. PMID:22811815

Fakih, Marwan G; Yang, Gary Y

2010-01-01

3

Efficacy of Intensity Modulated Radiation Therapy After Surgery in Early Stage of Esophageal Carcinoma;  

ClinicalTrials.gov

Esophageal Neoplasm; Esophageal Cancer TNM Staging Primary Tumor (T) T2; Esophageal Cancer TNM Staging Primary Tumor (T) T3; Esophageal Cancer TNM Staging Regional Lymph Nodes (N) N0; Esophageal Cancer TNM Staging Distal Metastasis (M) M0

2012-12-28

4

Endoscopic options for early stage esophageal cancer  

PubMed Central

Surgery has traditionally been the preferred treatment for early stage esophageal cancer. Recent advances in endoscopic treatments have been shown to be effective and safe. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow endoscopists to remove small, superficial lesions, providing tumor specimen that can be examined for accurate pathologic tumor staging and assessment of adequacy of resection. Endoscopic ablation procedures, including photodynamic therapy (PDT) and radio frequency ablation (RFA), have also been shown to safely and effectively treat esophageal dysplasia and early stage neoplasia, with excellent long-term disease control. Both approaches are becoming more widely available around the world, and provide an alternative, safe, low risk strategy for treating early stage disease, making combined endoscopic therapy the recommended treatment of choice for early stage esophageal cancers. PMID:25642334

Shah, Pari M.

2015-01-01

5

Prognostic and predictive significance of MSI in stages II/III colon cancer  

PubMed Central

In colon cancer, classic disease staging remains the key prognosis and treatment determinant. Although adjuvant chemotherapy has an established role in stage III colon cancer patients, in stage II it is still a subject of controversy due to its restriction to a small subgroup of patients with high-risk histopathologic features. Patients with stage II tumors form a highly heterogeneous group, with five-year relative overall survival rates ranging from 87.5% (IIA) to 58.4% (IIC). Identifying those for whom adjuvant chemotherapy would be appropriate and necessary has been challenging, and prognostic markers which could serve in the selection of patients more likely to recur or benefit from adjuvant chemotherapy are eagerly needed. The stronger candidate in this category seems to be microsatellite instability (MSI). The recently reported European Society for Medical Oncology guidelines suggest that MSI should be evaluated in stage II colorectal cancer patients in order to contribute in treatment decision-making regarding chemotherapy administration. The hypothetical predictive role of MSI regarding its response to 5-fluorouracil-based adjuvant chemotherapy has proven a much more difficult issue to address. Almost every possible relation between MSI and chemotherapy outcome has been described in the adjuvant colon cancer setting in the international literature, and the matter is far from being settled. In this current report we critically evaluate the prognostic and predictive impact of MSI status in patients with stage II and stage III colon cancer patients. PMID:24944470

Saridaki, Zacharenia; Souglakos, John; Georgoulias, Vassilis

2014-01-01

6

Role of Postmastectomy Radiation After Neoadjuvant Chemotherapy in Stage II-III Breast Cancer  

SciTech Connect

Purpose: To identify a cohort of women treated with neoadjuvant chemotherapy and mastectomy for whom postmastectomy radiation therapy (PMRT) may be omitted according to the projected risk of local-regional failure (LRF). Methods and Materials: Seven breast cancer physicians from University of California cancer centers created 14 hypothetical clinical case scenarios, identified, reviewed, and abstracted the available literature (MEDLINE and Cochrane databases), and formulated evidence tables with endpoints of LRF, disease-free survival, and overall survival. Using the American College of Radiology appropriateness criteria methodology, appropriateness ratings for postmastectomy radiation were assigned for each scenario. Finally, an overall summary risk assessment table was developed. Results: Of 24 sources identified, 23 were retrospective studies from single institutions. Consensus on the appropriateness rating, defined as 80% agreement in a category, was achieved for 86% of the cases. Distinct LRF risk categories emerged. Clinical stage II (T1-2N0-1) patients, aged >40 years, estrogen receptor-positive subtype, with pathologic complete response or 0-3 positive nodes without lymphovascular invasion or extracapsular extension, were identified as having {<=}10% risk of LRF without radiation. Limited data support stage IIIA patients with pathologic complete response as being low risk. Conclusions: In the absence of randomized trial results, existing data can be used to guide the use of PMRT in the neoadjuvant chemotherapy setting. Using available studies to inform appropriateness ratings for clinical scenarios, we found a high concordance of treatment recommendations for PMRT and were able to identify a cohort of women with a low risk of LRF without radiation. These low-risk patients will form the basis for future planned studies within University of California Athena Breast Health Network.

Fowble, Barbara L., E-mail: bfowble@radonc.ucsf.edu [Department of Radiation Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA (United States); Einck, John P. [Department of Radiation Oncology, University of California, San Diego, CA (United States); Kim, Danny N. [Athena Breast Health Network, Program Management Office, San Francisco, CA (United States); McCloskey, Susan [Department of Radiation Oncology, University of California, Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA (United States); Mayadev, Jyoti [Department of Radiation Oncology, University of California, Davis Cancer Center, Sacramento, CA (United States); Yashar, Catheryn [Department of Radiation Oncology, University of California, San Diego, CA (United States); Chen, Steven L. [Department of Surgery, University of California, Davis Cancer Center, Sacramento, CA (United States); Hwang, E. Shelley [Department of Surgery, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA (United States)

2012-06-01

7

Post-chemoradiation surgical pathology stage can customize the surveillance strategy in patients with esophageal adenocarcinoma.  

PubMed

Current algorithms for surveillance of patients with esophageal adenocarcinoma (EAC) after chemoradiation and surgery (trimodality therapy [TMT]) remain empiric. The authors hypothesized that the frequency, type, and timing of relapses after TMT would be highly associated with surgical pathology stage (SPS), and therefore SPS could be used to individualize the surveillance strategy. Between 2000 and 2010, 518 patients with EAC were identified who underwent TMT at The University of Texas MD Anderson Cancer Center and were frequently surveyed. Frequency, type, and timing of the first relapse (locoregional and/or distant) were tabulated according to SPS. Standard statistical approaches were used. The median follow-up time after esophageal surgery was 55.4 months (range, 1.0-149.2 months). Disease relapse occurred in 215 patients (41.5%). Higher SPS was associated with a higher rate of relapse (0/I vs II/III, P?.001; 0/I vs II, P=.002; SPS 0/I vs III, P?.001; and SPS II vs III, P=.005) and with shorter time to relapse (P<.001). Irrespective of the SPS, approximately 95% of all relapses occurred within 36 months of surgery. The 3- and 5-year overall survival rates were shorter for patients with a higher SPS than those with a lower SPS (0/I vs II/III, P?.001; 0/I vs II, P?.001; 0/I vs III, P?.001; and II vs III, P=.014). The compelling data show an excellent association between SPS and frequency/type/timing of relapses after TMT in patients with EAC. Thus, the surveillance strategy can potentially be customized based on SPS. These data can inform a future evidence-based surveillance strategy that can be efficient and cost-effective. PMID:25099446

Taketa, Takashi; Sudo, Kazuki; Correa, Arlene M; Wadhwa, Roopma; Shiozaki, Hironori; Elimova, Elena; Campagna, Maria-Claudia; Blum, Mariela A; Skinner, Heath D; Komaki, Ritsuko U; Lee, Jeffrey H; Bhutani, Manoop S; Weston, Brian R; Rice, David C; Swisher, Stephen G; Maru, Dipen M; Hofstetter, Wayne L; Ajani, Jaffer A

2014-08-01

8

Bevacizumab, Fluorouracil, Leucovorin Calcium, and Oxaliplatin Before Surgery in Treating Patients With Stage II-III Rectal Cancer  

ClinicalTrials.gov

Mucinous Adenocarcinoma of the Rectum; Signet Ring Adenocarcinoma of the Rectum; Stage IIA Rectal Cancer; Stage IIB Rectal Cancer; Stage IIC Rectal Cancer; Stage IIIA Rectal Cancer; Stage IIIB Rectal Cancer; Stage IIIC Rectal Cancer

2014-11-20

9

Dissection of Immune Gene Networks in Primary Melanoma Tumors Critical for Antitumor Surveillance of Patients with Stage II–III Resectable Disease  

PubMed Central

Patients with resected stage II–III cutaneous melanomas remain at high risk for metastasis and death. Biomarker development has been limited by the challenge of isolating high-quality RNA for transcriptome-wide profiling from formalin-fixed and paraffin-embedded (FFPE) primary tumor specimens. Using NanoString technology, RNA from 40 stage II–III FFPE primary melanomas was analyzed and a 53-immune-gene panel predictive of non-progression (area under the curve (AUC)=0.920) was defined. The signature predicted disease-specific survival (DSS P<0.001) and recurrence-free survival (RFS P<0.001). CD2, the most differentially expressed gene in the training set, also predicted non-progression (P<0.001). Using publicly available microarray data from 46 primary human melanomas (GSE15605), a coexpression module enriched for the 53-gene panel was then identified using unbiased methods. A Bayesian network of signaling pathways based on this data identified driver genes. Finally, the proposed 53-gene panel was confirmed in an independent test population of 48 patients (AUC=0.787). The gene signature was an independent predictor of non-progression (P<0.001), RFS (P<0.001), and DSS (P=0.024) in the test population. The identified driver genes are potential therapeutic targets, and the 53-gene panel should be tested for clinical application using a larger data set annotated on the basis of prospectively gathered data. PMID:24522433

Sivendran, Shanthi; Chang, Rui; Pham, Lisa; Phelps, Robert G.; Harcharik, Sara T.; Hall, Lawrence D.; Bernardo, Sebastian G.; Moskalenko, Marina M.; Sivendran, Meera; Fu, Yichun; de Moll, Ellen H.; Pan, Michael; Moon, Jee Young; Arora, Sonali; Cohain, Ariella; DiFeo, Analisa; Ferringer, Tammie C.; Tismenetsky, Mikhail; Tsui, Cindy L.; Friedlander, Philip A.; Parides, Michael K.; Banchereau, Jacques; Chaussabel, Damien; Lebwohl, Mark G.; Wolchok, Jedd D.; Bhardwaj, Nina; Burakoff, Steven J.; Oh, William K.; Palucka, Karolina; Merad, Miriam; Schadt, Eric E.; Saenger, Yvonne M.

2014-01-01

10

Dissection of immune gene networks in primary melanoma tumors critical for antitumor surveillance of patients with stage II-III resectable disease.  

PubMed

Patients with resected stage II-III cutaneous melanomas remain at high risk for metastasis and death. Biomarker development has been limited by the challenge of isolating high-quality RNA for transcriptome-wide profiling from formalin-fixed and paraffin-embedded (FFPE) primary tumor specimens. Using NanoString technology, RNA from 40 stage II-III FFPE primary melanomas was analyzed and a 53-immune-gene panel predictive of non-progression (area under the curve (AUC)=0.920) was defined. The signature predicted disease-specific survival (DSS P<0.001) and recurrence-free survival (RFS P<0.001). CD2, the most differentially expressed gene in the training set, also predicted non-progression (P<0.001). Using publicly available microarray data from 46 primary human melanomas (GSE15605), a coexpression module enriched for the 53-gene panel was then identified using unbiased methods. A Bayesian network of signaling pathways based on this data identified driver genes. Finally, the proposed 53-gene panel was confirmed in an independent test population of 48 patients (AUC=0.787). The gene signature was an independent predictor of non-progression (P<0.001), RFS (P<0.001), and DSS (P=0.024) in the test population. The identified driver genes are potential therapeutic targets, and the 53-gene panel should be tested for clinical application using a larger data set annotated on the basis of prospectively gathered data. PMID:24522433

Sivendran, Shanthi; Chang, Rui; Pham, Lisa; Phelps, Robert G; Harcharik, Sara T; Hall, Lawrence D; Bernardo, Sebastian G; Moskalenko, Marina M; Sivendran, Meera; Fu, Yichun; de Moll, Ellen H; Pan, Michael; Moon, Jee Young; Arora, Sonali; Cohain, Ariella; DiFeo, Analisa; Ferringer, Tammie C; Tismenetsky, Mikhail; Tsui, Cindy L; Friedlander, Philip A; Parides, Michael K; Banchereau, Jacques; Chaussabel, Damien; Lebwohl, Mark G; Wolchok, Jedd D; Bhardwaj, Nina; Burakoff, Steven J; Oh, William K; Palucka, Karolina; Merad, Miriam; Schadt, Eric E; Saenger, Yvonne M

2014-08-01

11

Fulvestrant and/or Anastrozole in Treating Postmenopausal Patients With Stage II-III Breast Cancer Undergoing Surgery  

ClinicalTrials.gov

Estrogen Receptor-positive Breast Cancer; HER2-negative Breast Cancer; Invasive Ductal Breast Carcinoma; Invasive Lobular Breast Carcinoma; Recurrent Breast Cancer; Stage II Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

2014-03-05

12

Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer  

ClinicalTrials.gov

Adenocarcinoma of the Gastroesophageal Junction; Esophageal Adenocarcinoma; Stage IB Esophageal Cancer; Stage IIA Esophageal Cancer; Stage IIB Esophageal Cancer; Stage IIIA Esophageal Cancer; Stage IIIB Esophageal Cancer

2015-02-09

13

Thyroid Function in Women after Multimodal Treatment for Breast Cancer Stage II/III: Comparison With Controls From a Population Sample  

SciTech Connect

Purpose: A possible association between thyroid diseases (TD) and breast cancer (BC) has been debated. We examined prevalence and development of TD in women after multimodal treatment for Stage II/III BC compared with women from a general population. Secondarily, we explored the impact of two different radiotherapy (RT) techniques (standardized field arrangements vs. computed tomography [CT]-based dose planning) on TD in BC patients examined 35-120 months after primary BC treatment. Methods and Materials: A total of 403 BC patients completed a questionnaire about TD and had blood samples taken for analyses of thyroid function. All had undergone postoperative RT with or without (2%) adjuvant systemic treatment. The results in the BC patients were compared with a cancer-free, age-matched control group from a general population (CGr). Results: There was higher prevalence of self-reported hypothyroidism in the BC patients as compared with the CGr (18% vs. 6%, p < 0.001). The raised prevalence was predominantly due to a substantial increase in the development of hypothyroidism after BC diagnosis, whereas the prevalence of hypothyroidism before BC diagnosis was similar to that observed in the CGr. Patients treated with CT-based RT showed a trend for increased post-BC development of hypothyroidism as compared with those treated with standardized field arrangements (p = 0.08). Conclusions: Hypothyroidism is significantly increased in women after multimodal treatment for Stage II/III BC. Radiation to the thyroid gland may be a contributing factor. BC patients should be routinely screened for hypothyroidism.

Reinertsen, Kristin Valborg, E-mail: kvr@radiumhospitalet.n [Department of Clinical Cancer Research, Norwegian Radium Hospital, Rikshospitalet University Hospital, 0310 Oslo (Norway); Faculty Division the Norwegian Radium Hospital, University of Oslo, 0316 Oslo (Norway); Cancer Center, Ulleval University Hospital, Oslo (Norway); Cvancarova, Milada [Department of Clinical Cancer Research, Norwegian Radium Hospital, Rikshospitalet University Hospital, 0310 Oslo (Norway); Wist, Erik [Cancer Center, Ulleval University Hospital, Oslo (Norway); Faculty of medicine, University of Oslo, PO Box 1130 Blindern, 0318 Oslo (Norway); Bjoro, Trine [Department of Medical Biochemistry, Rikshospitalet University Hospital, 0027 Oslo (Norway); Faculty Division Rikshospitalet University Hospital, PO Box 1171, Blindern 0318 Oslo (Norway); Dahl, Alv A. [Department of Clinical Cancer Research, Norwegian Radium Hospital, Rikshospitalet University Hospital, 0310 Oslo (Norway); Faculty Division the Norwegian Radium Hospital, University of Oslo, 0316 Oslo (Norway); Danielsen, Turi [Department of Medical Physics, Norwegian Radium Hospital, Rikshospitalet University Hospital, 0310 Oslo (Norway); Fossa, Sophie D. [Department of Clinical Cancer Research, Norwegian Radium Hospital, Rikshospitalet University Hospital, 0310 Oslo (Norway); Faculty Division the Norwegian Radium Hospital, University of Oslo, 0316 Oslo (Norway)

2009-11-01

14

Radiographic and endosonographic staging in esophageal cancer.  

PubMed

Radiographic imaging using computed tomographic (CT) scan and positron emission tomography/CT are primarily helpful in identifying distant metastases. In general, if patients have evidence of lymph node involvement that is proved pathologically by endoscopic ultrasound/fine needle aspiration, this information is considered definitive, and the patient can be referred for the appropriate stage-specific therapy. Laparoscopy combined with laparoscopic ultrasound and peritoneal lavage has been shown to have sensitivity of 67% and specificity of 92% for lymph node disease. Thoracoscopy may help identify involved lymph node in the mediastinum before resection and help determine the field of radiation. PMID:24199695

Krasna, Mark J

2013-11-01

15

EFFECT OF POSTMASTECTOMY RADIOTHERAPY IN PATIENTS <35 YEARS OLD WITH STAGE II–III BREAST CANCER TREATED WITH DOXORUBICIN-BASED NEOADJUVANT CHEMOTHERAPY AND MASTECTOMY  

PubMed Central

Purpose Postmastectomy radiotherapy (PMRT) improves locoregional control (LRC) in patients with high-risk features after mastectomy. Young age continues to evolve as a potentially important risk factor. The objective of this study was to assess the benefits of PMRT in patients <35 years old treated with doxorubicin-based neoadjuvant chemotherapy for Stage II–III breast cancer. Patients and Methods We retrospectively analyzed 107 consecutive breast cancer patients <35 years old with Stage IIA–IIIC disease treated at our institution with doxorubicin-based neoadjuvant chemotherapy and mastectomy, with or without PMRT. The treatment groups were compared in terms of LRC and overall survival. Results Despite more advanced disease stages, the patients who received PMRT (n = 80) had greater rates of LRC (5-year rate, 88% vs. 63%, p = 0.001) and better overall survival (5-year rate, 67% vs. 48%, p = 0.03) than patients who did not receive PMRT (n = 27). Conclusion Among breast cancer patients <35 years old at diagnosis, the use of PMRT after doxorubicin-based neoadjuvant chemotherapy and mastectomy led to a statistically greater rate of LRC and overall survival compared with patients without PMRT. The benefit seen for PMRT in young patients provides valuable data to better tailor adjuvant, age-specific treatment decisions after mastectomy. PMID:17855016

Garg, Amit K.; Oh, Julia L.; Oswald, Mary Jane; Huang, Eugene; Strom, Eric A.; Perkins, George H.; Woodward, Wendy A.; Yu, T. Kuan; Tereffe, Welela; Meric-Bernstam, Funda; Hahn, Karin; Buchholz, Thomas A.

2011-01-01

16

Vaccine Therapy and Cyclophosphamide in Treating Patients With Stage II-III Breast or Stage II-IV Ovarian, Primary Peritoneal, or Fallopian Tube Cancer  

ClinicalTrials.gov

Recurrent Breast Cancer; Recurrent Fallopian Tube Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Primary Peritoneal Cavity Cancer; Stage II Breast Cancer; Stage IIA Breast Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Epithelial Cancer; Stage IIA Primary Peritoneal Cavity Cancer; Stage IIB Breast Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Epithelial Cancer; Stage IIB Primary Peritoneal Cavity Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Epithelial Cancer; Stage IIC Primary Peritoneal Cavity Cancer; Stage IIIA Breast Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Epithelial Cancer; Stage IIIA Primary Peritoneal Cavity Cancer; Stage IIIB Breast Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Epithelial Cancer; Stage IIIB Primary Peritoneal Cavity Cancer; Stage IIIC Breast Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Epithelial Cancer; Stage IIIC Primary Peritoneal Cavity Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Epithelial Cancer; Stage IV Primary Peritoneal Cavity Cancer

2014-11-20

17

Ovarian Ablation Using Goserelin Improves Survival of Premenopausal Patients with Stage II/III Hormone Receptor-Positive Breast Cancer without Chemotherapy-Induced Amenorrhea  

PubMed Central

Purpose The purpose of this study was to assess the value of ovarian ablation using goserelin in premenopausal patients with stage II/III hormone receptor-positive breast cancer without chemotherapy-induced amenorrhea (CIA). Materials and Methods We retrospectively reviewed the data of breast patients treated between October 1999 and November 2007 without CIA. The Kaplan-Meier method was used for calculation of the survival rate. Log rank method and Cox regression analysis were used for univariate and multivariate prognostic analysis. Results The median follow-up period was 61 months. Initially, 353 patients remained without CIA after chemotherapy and 98 among those who received goserelin and tamoxifen (TAM). In univariate analysis, goserelin improved locoregional recurrence-free survival (LRFS) (98.9% vs. 94.1%, p=0.041), distant metastasis-free survival (DMFS) (85.4% vs. 71.9%, p=0.006), disease-free survival (DFS) (85.4% vs. 71.6%, p=0.005), and overall survival (OS) (93.5% vs. 83.5%, p=0.010). In multivariate analysis, goserelin treatment was an independent factor influencing DMFS (hazard ratio [HR], 1.603; 95% confidence interval [CI], 1.228 to 2.092; p=0.001), DFS (HR, 1.606; 95% CI, 1.231 to 2.096; p=0.001), and OS (HR, 3.311; 95% CI, 1.416 to 7.742; p=0.006). In addition, treatment with goserelin resulted in significantly improved LRFS (p=0.039), DMFS (p=0.043), DFS (p=0.036), and OS (p=0.010) in patients aged < 40 years. In patients aged ? 40 years, goserelin only improved DMFS (p=0.028) and DFS (p=0.027). Conclusion Ovarian ablation with goserelin plus TAM resulted in significantly improved therapeutic efficacy in premenopausal patients with stage II/III hormone receptor-positive breast cancer without CIA. PMID:25187267

Zhou, Juan; Wu, San-Gang; Wang, Jun-Jie; Sun, Jia-Yuan; Li, Feng-Yan; Lin, Qin; Lin, Huan-Xin; He, Zhen-Yu

2015-01-01

18

Feasibility of radiotherapy after high-dose dense chemotherapy with epirubicin, preceded by dexrazoxane, and paclitaxel for patients with high-risk Stage II-III breast cancer  

SciTech Connect

Purpose: To verify the feasibility of, and quantify the risk of, pneumonitis from locoregional radiotherapy (RT) after high-dose dense chemotherapy with epirubicin and paclitaxel with peripheral blood progenitor cell support in patients with high-risk Stage II-III breast cancer. Methods and Materials: Treatment consisted of a mobilizing course of epirubicin 150 mg/m{sup 2}, preceded by dexrazoxane (Day 1), paclitaxel 175 mg/m{sup 2} (Day 2), and filgrastim; followed by three courses of epirubicin 150 mg/m{sup 2}, preceded by dexrazoxane (Day 1), paclitaxel 400 mg/m{sup 2} (Day 2), and peripheral blood progenitor cell support and filgrastim, every 16-19 days. After chemotherapy, patients were treated with locoregional RT, which included the whole breast or the chest wall, axilla, and supraclavicular area. Results: Overall, 64 of 69 patients were evaluable. The interval between the end of chemotherapy and the initiation of RT was at least 1.5-2 months (mean 2). No treatment-related death was reported. After a median follow-up of 27 months from RT (range 5-77 months), neither clinically relevant radiation pneumonitis nor congestive heart failure had been reported. Minor and transitory lung and cardiac toxicities were observed. Conclusion: Sequential high doses of epirubicin, preceded by dexrazoxane, and paclitaxel did not adversely affect the tolerability of locoregional RT in breast cancer patients. The risk of pneumonitis was not affected by the use of sequential paclitaxel with an interval of at least 1.5-2 months between the end of chemotherapy and the initiation of RT. Long-term follow-up is needed to define the risk of cardiotoxicity in these patients.

De Giorgi, Ugo [Istituto Oncologico Romagnolo, Department of Medical Oncology, Santa Maria delle Croci Hospital, Ravenna (Italy)]. E-mail: ugo_degiorgi@yahoo.com; Giannini, Massimo [Istituto Oncologico Romagnolo, Department of Radiotherapy, Santa Maria delle Croci Hospital, Ravenna (Italy); Department of Radiotherapy, Pierantoni Hospital, Forli (Italy); Frassineti, Luca [Department of Medical Oncology, Pierantoni Hospital, Forli (Italy); Kopf, Barbara [Istituto Oncologico Romagnolo, Department of Medical Oncology, Santa Maria delle Croci Hospital, Ravenna (Italy); Palazzi, Silvia [Istituto Oncologico Romagnolo, Department of Radiotherapy, Santa Maria delle Croci Hospital, Ravenna (Italy); Giovannini, Noemi [Department of Medical Oncology, Pierantoni Hospital, Forli (Italy); Zumaglini, Federica [Istituto Oncologico Romagnolo, Department of Medical Oncology, Santa Maria delle Croci Hospital, Ravenna (Italy); Rosti, Giovanni [Istituto Oncologico Romagnolo, Department of Medical Oncology, Santa Maria delle Croci Hospital, Ravenna (Italy); Emiliani, Ermanno [Istituto Oncologico Romagnolo, Department of Radiotherapy, Santa Maria delle Croci Hospital, Ravenna (Italy); Marangolo, Maurizio [Istituto Oncologico Romagnolo, Department of Medical Oncology, Santa Maria delle Croci Hospital, Ravenna (Italy)

2006-07-15

19

Ordering of mutations in preinvasive disease stages of esophageal carcinogenesis.  

PubMed

Cancer genome sequencing studies have identified numerous driver genes, but the relative timing of mutations in carcinogenesis remains unclear. The gradual progression from premalignant Barrett's esophagus to esophageal adenocarcinoma (EAC) provides an ideal model to study the ordering of somatic mutations. We identified recurrently mutated genes and assessed clonal structure using whole-genome sequencing and amplicon resequencing of 112 EACs. We next screened a cohort of 109 biopsies from 2 key transition points in the development of malignancy: benign metaplastic never-dysplastic Barrett's esophagus (NDBE; n=66) and high-grade dysplasia (HGD; n=43). Unexpectedly, the majority of recurrently mutated genes in EAC were also mutated in NDBE. Only TP53 and SMAD4 mutations occurred in a stage-specific manner, confined to HGD and EAC, respectively. Finally, we applied this knowledge to identify high-risk Barrett's esophagus in a new non-endoscopic test. In conclusion, mutations in EAC driver genes generally occur exceptionally early in disease development with profound implications for diagnostic and therapeutic strategies. PMID:24952744

Weaver, Jamie M J; Ross-Innes, Caryn S; Shannon, Nicholas; Lynch, Andy G; Forshew, Tim; Barbera, Mariagnese; Murtaza, Muhammed; Ong, Chin-Ann J; Lao-Sirieix, Pierre; Dunning, Mark J; Smith, Laura; Smith, Mike L; Anderson, Charlotte L; Carvalho, Benilton; O'Donovan, Maria; Underwood, Timothy J; May, Andrew P; Grehan, Nicola; Hardwick, Richard; Davies, Jim; Oloumi, Arusha; Aparicio, Sam; Caldas, Carlos; Eldridge, Matthew D; Edwards, Paul A W; Rosenfeld, Nitzan; Tavaré, Simon; Fitzgerald, Rebecca C

2014-08-01

20

Expression of Livin and vascular endothelial growth factor in different clinical stages of human esophageal carcinoma  

PubMed Central

AIM: To investigate the role of Livin and vascular endothelial growth factor (VEGF) in human esophageal carcinoma, and analyze its relationship to clinical stages. METHODS: Expression of Livin in fresh esophageal cancer tissues was detected by immunohistochemistry (IHC), Western blotting and reverse transcriptase-polymerase chain reaction (RT-PCR), and VEGF by Western blotting and RT-PCR. All statistical analyses were performed by SPSS version 11.0. RESULTS: Livin positivity was also significantly correlated with tumor stages, increasing with tumor progression. Expression of Livin and VEGF increased with the process of esophageal carcinoma. In the fourth clinical stage, expression of Livin and VEGF was the most significant. Expression of Livin was positively correlated with VEGF. CONCLUSION: Over-expression of Livin and VEGF contributes to the pathogenesis of esophageal carcinoma. PMID:18837095

Chen, Li; Ren, Guo-Sheng; Li, Fan; Sun, Shan-Quan

2008-01-01

21

MTHFR-1298 A>C (rs1801131) is a predictor of survival in two cohorts of stage II/III colorectal cancer patients treated with adjuvant fluoropyrimidine chemotherapy with or without oxaliplatin.  

PubMed

Adjuvant treatment based on fluoropyrimidines (FL) improves the prognosis of stage II/III colorectal cancer (CRC). Validated predictive/prognostic biomarkers would spare therapy-related morbidity in patients with a good prognosis. We compared the impact of a set of 22 FL-related polymorphisms with the prognosis of two cohorts of CRC patients treated with adjuvant FL with or without OXA, including a total of 262 cases. 5,10-Methylentetrahydrofolate reductase (MTHFR) MTHFR-1298 A>C (rs1801131) polymorphism had a concordant effect: MTHFR-rs1801131-1298CC genotype carriers had a worse disease free survival (DFS) in both the cohorts. In the pooled population MTHFR-rs1801131-1298CC carriers had also a worse overall survival. We computed a clinical score related to DFS including MTHFR-rs1801131, tumor stage, sex and tumor location, where rs1801131 is the most detrimental factor (hazard ratio=5.3, 95% confidence interval=2.2-12.9; P-value=0.0006). MTHFR-rs1801131 is a prognostic factor that could be used as an additional criteria for the choice of the proper adjuvant regimen in stage II/III colorectal cancer patients.The Pharmacogenomics Journal advance online publication, 21 October 2014; doi:10.1038/tpj.2014.64. PMID:25331073

Cecchin, E; Perrone, G; Nobili, S; Polesel, J; De Mattia, E; Zanusso, C; Petreni, P; Lonardi, S; Pella, N; D'Andrea, M; Errante, D; Rizzolio, F; Mazzei, T; Landini, I; Mini, E; Toffoli, G

2014-10-21

22

Pre-chemotherapy 18F-FDG PET/CT upstages nodal stage in stage II-III breast cancer patients treated with neoadjuvant chemotherapy.  

PubMed

In breast cancer patients treated with neoadjuvant chemotherapy (NAC) the number of tumor-positive nodes can no longer reliably be determined. Furthermore, ultrasound (US) seems suboptimal for the detection of N3-disease. Therefore we assessed the proportion of breast cancer patients treated with NAC in which pre-chemotherapy 18F-FDG PET/CT detected ?4 axillary nodes or occult N3-disease, upstaging nodal status and changing risk estimation for locoregional recurrence (LRR). Conventional regional staging consisted of US with fine needle aspiration and/or sentinel lymph node biopsy. Patients were classified as low-risk (cT2N0), intermediate-risk (cT0N1, cT1N1, cT2N1, cT3N0), or high-risk (cT3N1, cT4, cN2-3) for LRR. The presence and number of FDG-avid nodes were evaluated and the proportion of patients that would be upstaged by PET/CT, based on detection of ?4 FDG-avid axillary nodes defined as cN2(4+) or occult N3-disease, was calculated. In total, 87 of 278 patients were considered high-risk based on conventional staging. PET/CT detected occult N3-disease in 5 (11 %) of 47 low-risk patients. In 144 intermediate-risk patients, PET/CT detected ?4 FDG-avid nodes in 24 (17 %) patients and occult N3-disease in 22 (15 %) patients, thereby finally upstaging 38 (26 %) of intermediate-risk patients. Of 43 (23 %) upstaged patients, 18 were ypN0, 12 were ypN1, and 13 were ypN2-3. Pre-chemotherapy PET/CT is valuable for selection of breast cancer patients at high risk for LRR. In our population, 23 % of patients treated with NAC were upstaged to the high-risk group based on PET/CT information, potentially benefiting from regional radiotherapy. PMID:24002735

Koolen, Bas B; Valdés Olmos, Renato A; Vogel, Wouter V; Vrancken Peeters, Marie Jeanne T F D; Rodenhuis, Sjoerd; Rutgers, Emiel J Th; Elkhuizen, Paula H M

2013-09-01

23

New TNM staging system for esophageal cancer: what chest radiologists need to know.  

PubMed

Esophageal cancer is a leading cause of cancer-related deaths worldwide, and the 5-year relative survival rate remains less than 20% in the United States. The treatment of esophageal cancer should be stage specific for better clinical outcomes. Recent treatment paradigms tend to involve a multimodality approach to management, which includes surgical resection and preoperative or definitive chemoradiation therapy. Accurate pretreatment staging of esophageal cancer is integral for assessing operability and determining a suitable treatment plan. The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) have published the seventh edition of the staging manual for cancer in the esophagus and esophagogastric junction. Unlike the sixth edition, the revised staging manual is data driven and harmonized with the staging of stomach cancer. Improvements include new definitions for the anatomic classifications Tis, T4, regional lymph node, N, and M and the addition of nonanatomic cancer characteristics (histopathologic cell type, histologic grade, and cancer location). Given the recent increase in the incidence of adenocarcinoma of the distal esophagus, esophagogastric junction, and gastric cardia, the staging of tumors in the esophagogastric junction has been addressed. Radiologists must understand the details of the seventh edition of the AJCC-UICC staging system for esophageal cancer and use appropriate imaging modalities, such as computed tomography (CT), endoscopic ultrasonography, and positron emission tomography/CT, for initial staging. PMID:25310426

Hong, Su Jin; Kim, Tae Jung; Nam, Kyung Bum; Lee, In Sun; Yang, Hee Chul; Cho, Sukki; Kim, Kwhanmien; Jheon, Sanghoon; Lee, Kyung Won

2014-10-01

24

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities  

PubMed Central

Esophageal cancer is a serious malignancy with regards to mortality and prognosis. It is a growing health concern that is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most common histological type of esophageal cancer worldwide, with a higher incidence in developing nations. With the increased prevalence of gastroesophageal reflux disease and obesity in developed nations, the incidence of esophageal adenocarcinoma has dramatically increased in the past 40 years. Esophageal cancer is staged according to the widely accepted TNM system. Staging plays an integral part in guiding stage specific treatment protocols and has a great impact on overall survival. Common imaging modalities used in staging include computed tomography, endoscopic ultrasound and positron emission tomography scans. Current treatment options include multimodality therapy mainstays of current treatment include surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy. PMID:24834141

Napier, Kyle J; Scheerer, Mary; Misra, Subhasis

2014-01-01

25

Bevacizumab and Intravenous or Intraperitoneal Chemotherapy in Treating Patients With Stage II-III Ovarian Epithelial Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer  

ClinicalTrials.gov

Malignant Ovarian Mixed Epithelial Tumor; Ovarian Brenner Tumor; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mucinous Cystadenocarcinoma; Ovarian Serous Cystadenocarcinoma; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Cancer; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Cancer; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Primary Peritoneal Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Cancer; Stage IIIB Primary Peritoneal Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Cancer; Stage IIIC Primary Peritoneal Cancer; Undifferentiated Ovarian Carcinoma

2015-02-09

26

Akt Inhibitor MK-2206 and Anastrozole With or Without Goserelin Acetate in Treating Patients With Stage II-III Breast Cancer  

ClinicalTrials.gov

Estrogen Receptor Positive; HER2/Neu Negative; Recurrent Breast Carcinoma; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

2014-11-25

27

Akt Inhibitor MK-2206 and Anastrozole With or Without Goserelin Acetate in Treating Patients With Stage II-III Breast Cancer  

ClinicalTrials.gov

Estrogen Receptor Positive; HER2/Neu Negative; Recurrent Breast Carcinoma; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer

2015-02-03

28

The Role of Postmastectomy Radiation Therapy After Neoadjuvant Chemotherapy in Clinical Stage II-III Breast Cancer Patients With pN0: A Multicenter, Retrospective Study (KROG 12-05)  

SciTech Connect

Purpose: The purpose of this study was to investigate the role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) in clinical stage II-III breast cancer patients with pN0. Methods and Materials: We retrospectively identified 417 clinical stage II-III breast cancer patients who achieved an ypN0 at surgery after receiving NAC between 1998 and 2009. Of these, 151 patients underwent mastectomy after NAC. The effect of PMRT on disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and overall survival (OS) was evaluated by multivariate analysis including known prognostic factors using the Kaplan-Meier method and compared using the log–rank test and Cox proportional regression analysis. Results: Of the 151 patients who underwent mastectomy, 105 (69.5%) received PMRT and 46 patients (30.5%) did not. At a median follow-up of 59 months, 5 patients (3.3%) developed LRR (8 sites of recurrence) and 14 patients (9.3%) developed distant metastasis. The 5-year DFS, LRRFS, and OS rates were 91.2, 98.1, and 93.3% with PMRT and 83.0%, 92.3%, and 89.9% without PMRT, respectively (all P values not significant). By univariate analysis, only age (?40 vs >40 years) was significantly associated with decreased DFS (P=.027). By multivariate analysis, age (?40 vs >40 years) and pathologic T stage (0-is vs 1 vs 2-4) were significant prognostic factors affecting DFS (hazard ratio [HR] 0.353, 95% confidence interval [CI] 0.135-0.928, P=.035; HR 2.223, 95% CI 1.074-4.604, P=.031, respectively). PMRT showed no correlation with a difference in DFS, LRRFS, or OS by multivariate analysis. Conclusions: PMRT might not be necessary for pN0 patients after NAC, regardless of clinical stage. Prospective randomized clinical trial data are needed to assess whether PMRT can be safely omitted in pN0 patients after NAC and mastectomy for clinical stage II-III breast cancer.

Shim, Su Jung [Department of Radiation Oncology, Eulji General Hospital, College of Medicine, Eulji University, Seoul (Korea, Republic of); Park, Won, E-mail: wonro.park@samsung.com [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Huh, Seung Jae; Choi, Doo Ho [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Shin, Kyung Hwan [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Lee, Nam Kwon [Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang (Korea, Republic of); Department of Radiation Oncology, Korea Medical Center, Korea University, School of Medicine, Seoul (Korea, Republic of); Suh, Chang-Ok; Keum, Ki Chang; Kim, Yong Bae [Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Ahn, Seung Do; Kim, Su Ssan [Department of Radiation Oncology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of); Ha, Sung W.; Chie, Eui Kyu; Kim, Kyubo [Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Shin, Hyun Soo [Department of Radiation Oncology, Bundang CHA Hospital, School of Medicine, CHA University, Seongnam (Korea, Republic of); Kim, Jin Hee [Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Lee, Hyung-Sik [Department of Radiation Oncology, Dong-A University Hospital, Dong-A University School of Medicine, Busan (Korea, Republic of)

2014-01-01

29

Pegylated Liposomal Doxorubicin Hydrochloride and Carboplatin Followed by Surgery and Paclitaxel in Treating Patients With Triple Negative Stage II-III Breast Cancer  

ClinicalTrials.gov

Estrogen Receptor-negative Breast Cancer; HER2-negative Breast Cancer; Progesterone Receptor-negative Breast Cancer; Stage IIA Breast Cancer; Stage IIB Breast Cancer; Stage IIIA Breast Cancer; Stage IIIB Breast Cancer; Stage IIIC Breast Cancer; Triple-negative Breast Cancer

2014-12-09

30

Measurement of the human esophageal cancer in an early stage with Raman spectroscopy  

NASA Astrophysics Data System (ADS)

The esophageal cancer has a tendency to transfer to another part of the body and the surgical operation itself sometimes gives high risk in vital function because many delicate organs exist near the esophagus. So the esophageal cancer is a disease with a high mortality. So, in order to lead a higher survival rate five years after the cancer's treatment, the investigation of the diagnosis methods or techniques of the cancer in an early stage and support the therapy are required. In this study, we performed the ex vivo experiments to obtain the Raman spectra from normal and early-stage tumor (stage-0) human esophageal sample by using Raman spectroscopy. The Raman spectra are collected by the homemade Raman spectrometer with the wavelength of 785 nm and Raman probe with 600-um-diameter. The principal component analysis (PCA) is performed after collection of spectra to recognize which materials changed in normal part and cancerous pert. After that, the linear discriminant analysis (LDA) is performed to predict the tissue type. The result of PCA indicates that the tumor tissue is associated with a decrease in tryptophan concentration. Furthermore, we can predict the tissue type with 80% accuracy by LDA which model is made by tryptophan bands.

Maeda, Yasuhiro; Ishigaki, Mika; Taketani, Akinori; Andriana, Bibin B.; Ishihara, Ryu; Sato, Hidetoshi

2014-02-01

31

Prognostic impact of clinicopathologic parameters in stage II\\/III breast cancer treated with neoadjuvant docetaxel and doxorubicin chemotherapy: paradoxical features of the triple negative breast cancer  

Microsoft Academic Search

BACKGROUND: Prognostic factors in locally advanced breast cancer treated with neoadjuvant chemotherapy differ from those of early breast cancer. The purpose of this study was to identify the clinical significance of potential predictive and prognostic factors in breast cancer patients treated by neoadjuvant chemotherapy. METHODS: A total of 145 stage II and III breast cancer patients received neoadjuvant docetaxel\\/doxorubicin chemotherapy

Bhumsuk Keam; Seock-Ah Im; Hee-Jun Kim; Do-Youn Oh; Jee Hyun Kim; Se-Hoon Lee; Eui Kyu Chie; Wonshik Han; Dong-Wan Kim; Woo Kyung Moon; Tae-You Kim; In Ae Park; Dong-Young Noh; Dae Seog Heo; Sung Whan Ha; Yung-Jue Bang

2007-01-01

32

1. : , , I, II, III 2. : .  

E-print Network

[] KAIST 2011 8 18 1. : , , I, II, III 2. : . · : (MAS109), (MAS212) · : I (MAS241:00­11:30 : · 12:30­14:00 : · 14:30­16:00 : I · 16:30­18:00 : II 1 #12;, 2011.08.18 KAIST : Problem 1 Let M) Prove that A is not diagonalizable. (b) Find the Jordan form of A. 2 #12; [] KAIST 2011 8 18 1

Kim, Yong Jung

33

Concordance of studies for nodal staging is prognostic for worse survival in esophageal cancer.  

PubMed

Pretreatment clinical staging in esophageal cancer influences prognosis and treatment strategy. Current staging strategies utilize multiple imaging modalities, and often the results are contradictory. No studies have examined the implications of concordance of computed tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS) when used for the evaluation of nodal disease. The objective of this study was to determine if concordance of CT, PET, or EUS for nodal disease predicts worse overall survival. We reviewed 615 esophageal cancer patients with pretreatment CT, PET, and EUS that underwent esophagectomy for survival outcomes based on concordance of studies for nodal disease. Concordant N+ is defined as two or three studies positive for nodal disease; non-concordant N+ is defined as only one positive study. Node-positive disease by any study predicted shorter survival than node-negative disease (42% vs. 73% 5-year survival; P<0.001). Additionally, non-concordant N+ patients had shorter survival than N- patients (52% vs. 73% 5-year survival; P<0.001). Concordant N+ patients had shorter survival than non-concordant N+ patients (38- vs. 61-month median survival; P=0.017). There were no statistically significant differences in survival based on specific combinations of studies. When PET was disregarded, patients with both?CT+ and EUS+ had shorter survival than patients with either?CT+ or EUS+ (39- vs. 58-month median survival; P=0.029). Pretreatment CT, PET, or EUS concordance for node-positive disease predicts shorter overall survival in patients that undergo esophagectomy for esophageal cancer. Predicting survival in esophageal cancer should consider the synergistic capabilities of CT, PET, and EUS in evaluating nodal status. PMID:24152134

Dhupar, R; Correa, A M; Ajani, J; Betancourt, S; Mehran, R J; Swisher, S G; Hofstetter, W L

2014-01-01

34

Positron emission tomography with F-18-fluorodeoxyglucose in a combined staging strategy of esophageal cancer prevents unnecessary surgical explorations  

Microsoft Academic Search

Distant metastases or local invasion are frequently found during the explorative phase of surgery for esophageal cancer. This\\u000a study was performed to determine the rate of patients with incurable disease encountered during exploration and to examine\\u000a the impact of preoperative staging, including positron emission tomography (PET), on the number of unnecessary explorations.\\u000a The records of 203 patients with esophageal cancer

Henderik L. van Westreenen; Pierre A. M. Heeren; Hendrik M. van Dullemen; Eric J. van der Jagt; Pieter L. Jager; Henk Groen; John Th. M. Plukker

2005-01-01

35

Concomitant boost IMRT-based neoadjuvant chemoradiotherapy for clinical stage II/III rectal adenocarcinoma: results of a phase II study  

PubMed Central

Aim This study was designed to evaluate the efficacy and toxicities of concomitant boost intensity-modulated radiation therapy (IMRT) along with capecitabine and oxaliplatin, followed by a cycle of Xelox, in neoadjuvant course for locally advanced rectal cancer. Materials and methods Patients with histologically confirmed, newly diagnosed, locally advanced rectal adenocarcinoma (cT3-T4 and/or cN+) located within 12 cm of the anal verge were included in this study. Patients received IMRT to the pelvis of 50 Gy and a concomitant boost of 5 Gy to the primary tumor in 25 fractions, and concurrent with oxaliplatin (50 mg/m2 d1 weekly) and capecitabine (625 mg/m2 bid d1–5 weekly). One cycle of Xelox (oxaliplatin 130 mg/m2 on d1 and capecitabine 1000 mg/m2 twice daily d1–14) was given two weeks after the completion of chemoradiation, and radical surgery was scheduled eight weeks after chemoradiation. Tumor response was evaluated by tumor regression grade (TRG) system and acute toxicities were evaluated by NCI-CTC 3.0 criteria. Survival curves were estimated using the Kaplan-Meier method and compared with Log-rank test. Results A total of 78 patients were included between March 2009 and May 2011 (median age 54 years; 62 male). Seventy-six patients underwent surgical resection. Twenty-eight patients underwent sphincter-sparing lower anterior resection and 18 patients (23.7%) were evaluated as pathological complete response (pCR). The incidences of grade 3 hematologic toxicity, diarrhea, and radiation dermatitis were 3.8%, 10.3%, and 17.9%, respectively. The three-year LR (local recurrence), DFS (disease-free survival) and OS (overall survival) rates were 14.6%, 63.8% and 77.4%, respectively. Initial clinical T stage and tumor regression were independent prognostic factors to DFS. Conclusion An intensified regimen of concomitant boost radiotherapy plus concurrent capecitabine and oxaliplatin, followed by one cycle of Xelox, can be safely administered in patients with locally advanced rectal cancer, and produces a high rate of pCR. A prognostic score model is helpful to distinguish different long-term prognosis groups in early stage. PMID:24606870

2014-01-01

36

1. : , , I, II, III 2. : .  

E-print Network

[] KAIST 2011 1 20 1. : , , I, II, III 2. : . · : (MAS109), (MAS212) · : I (MAS241:00­11:30 : · 12:30­14:00 : · 14:30­16:00 : I · 16:30­18:00 : II 1 #12;, 2011.01.20 KAIST : 1. Let A = 1 are orthogonal. 6. Let A = 1 0 0 1 2 0 0 0 3 . Express etA as a matrix, for t R. 2 #12; [] KAIST 2011

Kim, Yong Jung

37

Impact on Loco-regional Control of Radiochemotherapeutic Sequence and Time to Initiation of Adjuvant Treatment in Stage II/III Rectal Cancer Patients Treated with Postoperative Concurrent Radiochemotherapy  

PubMed Central

Purpose This study was designed to evaluate the impact of radiochemotherapeutic sequence and time to initiation of adjuvant treatment on loco-regional control for resected stage II and III rectal cancer. Materials and Methods Treatment outcomes for rectal cancer patients from two hospitals with different sequencing strategies regarding adjuvant concurrent radiochemotherapy (CRCT) were compared retrospectively. Pelvic radiotherapy was administered concurrently on the first (early CRCT, n=180) or the third cycle of chemotherapy (late CRCT, n=180). During radiotherapy, two cycles of fluorouracil were provided to patients in both groups. In the early CRCT group, median six cycles of fluorouracil and leucovorin were prescribed during the post-CRCT period. In the late CRCT group, two cycles of fluorouracil were administered in the pre- and post-CRCT periods. Results No significant differences in the 5-year loco-regional recurrence-free survival (LRRFS) (92.5% vs. 95.6%, p=0.43) or overall survival and disease-free survival were observed between groups. Patients who began receiving adjuvant treatment later than five weeks after surgery had lower LRRFS than patients who received adjuvant treatment within five weeks following surgery (79% vs. 91%, p<0.01). The risk of loco-regional recurrence increased as the time to initiation of adjuvant treatment was delayed. Conclusion In the current study, treatment outcomes were not significantly influenced by the sequence of adjuvant treatment but by the delay of adjuvant treatment for more than five weeks. Timely administration of adjuvant treatment is deemed important in achieving loco-regional tumor control for stage II/III rectal cancer patients. PMID:24851106

Kim, Haeyoung; Kim, Kyubo; Park, Won; Yoon, Won Sup; Huh, Seung Jae; Ha, Sung W.

2014-01-01

38

Long-term Survival Outcomes Following Internal Mammary Node Irradiation in Stage II-III Breast Cancer: Results of a Large Retrospective Study With 12-Year Follow-up  

SciTech Connect

Purpose: To examine the effect of internal mammary node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy. Methods and Materials: Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%. Results: The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI (P<.001). Otherwise, disease and treatment characteristics were well balanced. The 10-year DFS with and without IMNI was 65% and 57%, respectively (P=.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P=.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively (P=.62). The 10-year DFS and OS were 61%, and 69%, respectively. Conclusions: Internal mammary node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of internal mammary nodes should be considered in postmastectomy radiation therapy.

Chang, Jee Suk [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Won [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Yong Bae; Lee, Ik Jae; Keum, Ki Chang; Lee, Chang Geol [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Choi, Doo Ho [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Suh, Chang-Ok, E-mail: cosuh317@yuhs.ac [Department of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Huh, Seung Jae, E-mail: sjhuh@smc.samsung.co.kr [Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2013-08-01

39

Dosimetric Comparative Study of 3 Different Postoperative Radiotherapy Techniques (3D-CRT, IMRT, and RapidArc) for II-III Stage Rectal Cancer.  

PubMed

Postoperative radiotherapy is critical for reducing local relapse for advanced rectal carcinoma but has many side effects. Our study compared the dose distribution of target volumes, protection of normal organs at risk (OAR), and monitor unit (MU) for 3 radiotherapy techniques (3-dimensional conformal radiation therapy [3D-CRT], intensity-modulated radiation therapy [IMRT], and RapidArc (Varian Medical Systems, Inc., Palo Alto, CA, USA)). The results advocate for the clinical application of RapidArc technique in the future.Thirty postoperative patients with rectal cancer were enrolled. The 3 radiotherapy plans mentioned above were designed for each patient. The target volume coverage indicators included average dose, conformity index (CI), and homogeneity index (HI) of planning tumor volume (PTV). OAR included the bladder, small intestine, colon, and bilateral proximal femurs. The 30 patients were divided into 3 groups (10 cases in each group) for postoperative radiotherapy with the 3D-CRT, IMRT, or RapidArc technique, respectively.Both the IMRT and RapidArc plans have a significantly higher average PTV dose and better CI and HI (P?stage rectal cancer. PMID:25569661

Liu, Min; Liu, Bailong; Wang, Huidong; Ding, Lijuan; Shi, Yinghua; Ge, Chao; Su, Xu; Liu, Xiaodong; Dong, Lihua

2015-01-01

40

Esophageal actinomycosis in a patient with end-stage renal disease.  

PubMed

Actinomycosis of esophagus is uncommon. Herpes simplex virus, cytomegalovirus, candidiasis, tuberculosis, and other fungal infections are the commonly reported infections in both immunocompromised and immunocompetent patients. We report a case of esophageal actinomycosis in an end-stage renal disease patient. A 28-year-old lady, known case of systemic lupus erythematosus, hepatitis B virus infection with end-stage renal disease on regular maintenance hemodialysis since 5 years presented with history of epigastric pain and odynophagia for 1 week. Her upper gastrointestinal endoscopic examination revealed extensive necrotic areas with membrane in the esophagus. Histopathology revealed actinomycotic colonies and bacterial clumps. She was treated with intravenous penicillin followed by oral ampicillin for 6 months. She showed marked clinical improvement, and repeat endoscopy showed healing of ulceration and no evidence of actinomycosis. PMID:24393413

Nagaraju, Shankar Prasad; Kirpalani, Dilip Ashok; Bhabhe, Aditya S; Prasad, Raghvendra; Shah, Hardik; Kirpalani, Ashok L

2014-04-01

41

Endoscopic ultrasonography for staging of T1a and T1b esophageal squamous cell carcinoma  

PubMed Central

AIM: To investigate the accuracy of Endoscopic ultrasound (EUS) in staging and sub-staging T1a and T1b esophageal squamous cell carcinoma (ESCC). METHODS: A retrospective analysis involving 72 patients with pathologically confirmed T1a or T1b ESCC, was undertaken between January 2005 and December 2011 in Sun Yat-sen University Cancer Center. The accuracy and efficiency of EUS for detecting stages T1a and T1b ESCC were examined. RESULTS: The overall accuracy of EUS for detecting stage T1a or T1b ESCC was 70.8% (51/72), and the sensitivity was 74.3%. 77.8% (7/9) of lesions originated in the upper thoracic region, 73.1% (38/52) in the mid-thoracic region and 72.7% (8/11) in the lower thoracic region. Multivariate analysis revealed that the diagnostic accuracy of EUS was closely related to lesion length (F = 4.984, P = 0.029). CONCLUSION: EUS demonstrated median degree of accuracy for distinguishing between stages T1a and T1b ESCC. Therefore, it is necessary to improve EUS for staging early ESCC. PMID:24574809

He, Long-Jun; Shan, Hong-Bo; Luo, Guang-Yu; Li, Yin; Zhang, Rong; Gao, Xiao-Yan; Wang, Guo-Bao; Lin, Shi-Yong; Xu, Guo-Liang; Li, Jian-Jun

2014-01-01

42

Endoscopic Resection for Synchronous Esophageal Squamous Cell Carcinoma and Gastric Adenocarcinoma in Early Stage Is a Possible Alternative to Surgery  

PubMed Central

Background/Aims We investigated the clinical outcomes according to the method of treatment in synchronous esophageal and gastric cancer. Methods Synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma were diagnosed in 79 patients between 1996 and 2010. We divided the patients into four groups according to treatment; Group 1 received surgical resection for both cancers or surgery for gastric cancer with chemoradiotherapy for esophageal cancer (n=27); Group 2 was treated by endoscopic resection with or without additional treatment (n=14); Group 3 received chemoradiotherapy only (n=18); and Group 4 received supportive care only (n=20). Results The median survival times in groups 1 and 2 were 86 and 60 months, respectively. The recurrence rate and mortality were 23% and 48%, respectively, in group 1 and 21% and 4%, respectively, in group 2. The median survival time was 12 months in group 3 and 9 months in group 4. Multivariate analysis showed that age (p<0.001) and treatment group (p=0.019) were significantly associated with death. Compared with group 1, treatment in the intensive care unit (p=0.003), loss of body weight (p=0.042), and decrease in hemoglobin (p=0.033) were worse in group 1. Conclusions Endoscopic resection for synchronous esophageal and gastric cancer could be considered as a possible alternative to surgery for early-stage cancer. PMID:25170061

Park, Se Jeong; Ahn, Ji Yong; Jung, Hwoon-Yong; Na, Shin; Park, So-Eun; Kim, Mi-Young; Choi, Kwi-Sook; Lee, Jeong Hoon; Kim, Do Hoon; Choi, Kee Don; Song, Ho June; Lee, Gin Hyug; Kim, Jin-Ho; Han, Seungbong

2015-01-01

43

Patients with high body mass index tend to have lower stage of esophageal carcinoma at diagnosis.  

PubMed

High body mass index (H-BMI; ?25 kg/m(2) ) is common in US adults. In a small cohort of esophageal cancer (EC) patients treated with surgery, H-BMI and diagnosis of early stage EC appeared associated. We evaluated a much larger cohort of EC patients. From a prospectively maintained database, we analyzed 925 EC patients who had surgery with or without adjunctive therapy. Various statistical methods were used. Among 925 patients, 69% had H-BMI, and 31% had normal body mass index (<25 kg/m(2) ; N-BMI). H-BMI was associated with men (P<0.001), Caucasians (P=0.064; trend), lower esophageal localization (P<0.001), adenocarcinoma histology (P<0.001), low baseline cT-stage (P=0.003), low baseline overall clinical stage (P=0.003), coronary artery disease (P=0.036), and diabetes (P<0.001). N-BMI was associated with weight loss (P<0.001), alcohol abuse (P=0.056; trend), ever/current smoking (P=0.014), and baseline cN+ (P=0.018). H-BMI patients with cT1 tumors (n=110) had significantly higher rates of gastresophageal reflux disease symptoms (P<0.001), gastresophageal reflux disease history (P<0.001), and Barrett's esophagus history (P<0.001) compared with H-BMI patients with cT2 tumors (n=114). Median survival of N-BMI patients was 36.66 months compared with 53.20 months for H-BMI patients (P=0.005). In multivariate analysis, older age (P<0.001), squamous histology (P=0.002), smoking (P=0.040), weight loss (P=0.002), high baseline stage (P<0.001), high number of ypN+ (P=0.005), high surgical stage (P<0.001), and American Society of Anesthesia scores, three out of four (P<0.001) were independent prognosticators for poor overall survival. We were able to perform propensity-based analysis of surgical complications between H-BMI and N-BMI patients. A comparison of fully matched 376 patients (188 with H-BMI and 188 with N-BMI) found no significant differences in the rate of complications between the two groups. This larger data set confirms that a fraction of H-BMI patients with antecedent history is diagnosed with early baseline EC. Upon validation of our data in an independent cohort, refinements in surveillance of symptomatic H-BMI patients are warranted and could be implemented. Our data also suggest that H-BMI patients do not experience higher rate of surgical complications compared with N-BMI patients. PMID:22150920

Hayashi, Y; Correa, A M; Hofstetter, W L; Vaporciyan, A A; Mehran, R J; Rice, D C; Suzuki, A; Lee, J H; Bhutani, M S; Welsh, J; Lin, S H; Maru, D M; Swisher, S G; Ajani, J A

2012-01-01

44

FOLFOX-6 Induction Chemotherapy Followed by Esophagectomy and Post-operative Chemoradiotherapy in Patients With Esophageal Adenocarcinoma  

ClinicalTrials.gov

Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Adenocarcinoma of the Gastric Cardia; Stage IIIA Esophageal Cancer; Stage IIIB Esophageal Cancer; Stage IIIC Esophageal Cancer

2015-01-22

45

Cyclin E involved in early stage carcinogenesis of esophageal adenocarcinoma by SNP DNA microarray and immunohistochemical studies  

PubMed Central

Background Cyclin E is a cell cycle regulator which is critical for driving G1/S transition. Abnormal levels of cyclin E have been found in many cancers. However, the level changes of cyclin E in esophageal adenocarcinoma and its precancerous lesion have not been well studied. Here, we focus on the gene amplification and expression of cyclin E in these lesions, and aim to ascertain the relationship with clinicopathological characteristics. Methods Genomic DNA was analyzed from 116 esophageal adenocarcinoma and 26 precancerous lesion patients using Affymetrix SNP 6.0 arrays. The protein overexpression of cyclin E was also detected using immunohistochemistry from tissue microarrays containing esophageal adenocarcinoma and precancerous lesions. Patient survival and other clinical data were collected and analyzed. The intensity and percentage of the cyclin E expressing cells in tissue microarrays were scored by two pathologists. Fisher exact tests and Kaplan-Meier methods were used to analyze data. Results By genomic analysis, cyclin E was amplified in 19.0% of the EAC samples. By immunohistochemistry, high expression of cyclin E was observed in 2.3% of squamous mucosa tissues, 3.7% in columnar cell metaplasia, 5.8% in Barrett’s esophagus, 19.0% in low grade dysplasia, 35.7% in high grade dysplasia, and 16.7% in esophageal adenocarcinoma. The differences in cyclin E high expression between neoplastic groups and non-dysplasia groups are statistically significant (p?esophageal lesion to low and high grade dysplasia, suggesting that cyclin E plays an important role in the early stage of carcinogenesis. Importantly, cyclin E is also amplified and highly expressed in a subset of esophageal adenocarcinoma patients, but this increase is not associated with worse prognosis. PMID:24742107

2014-01-01

46

Image-Guided Hypofractionated Radiation Therapy With Stereotactic Body Radiation Therapy Boost and Combination Chemotherapy in Treating Patients With Stage II-III Non-Small Cell Lung Cancer That Cannot Be Removed By Surgery  

ClinicalTrials.gov

Adenocarcinoma of the Lung; Adenosquamous Cell Lung Cancer; Large Cell Lung Cancer; Recurrent Non-small Cell Lung Cancer; Squamous Cell Lung Cancer; Stage IIA Non-small Cell Lung Cancer; Stage IIB Non-small Cell Lung Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Non-small Cell Lung Cancer

2014-12-03

47

Risk of node metastasis of sentinel lymph nodes detected in level II/III of the axilla by single-photon emission computed tomography/computed tomography  

PubMed Central

In breast cancer, single-photon emission computed tomography/computed tomography (SPECT/CT) shows the exact anatomical location of sentinel nodes (SN). SPECT/CT mainly exposes axilla and partly exposes atypical sites of extra-axillary lymphatic drainage. The mechanism of how the atypical hot nodes are involved in lymphatic metastasis was retrospectively investigated in the present study, particularly at the level II/III region. SPECT/CT was performed in 92 clinical stage 0-IIA breast cancer patients. Sentinel lymph nodes are depicted as hot nodes in SPECT/CT. Patients were divided into two groups: With or without hot node in level II/III on SPECT/CT. The existence of metastasis in level II/III was investigated and the risk factors were identified. A total of 12 patients were sentinel lymph node biopsy metastasis positive and axillary lymph node dissection (ALND) was performed. These patients were divided into two groups: With and without SN in level II/III, and nodes in level II/III were pathologically proven. In 11 of the 92 patients, hot nodes were detected in level II/III. There was a significant difference in node metastasis depending on whether there were hot nodes in level II/III (P=0.0319). Multivariate analysis indicated that the hot nodes in level II/III and lymphatic invasion were independent factors associated with node metastasis. There were 12 SN-positive patients followed by ALND. In four of the 12 patients, hot nodes were observed in level II/III. Two of the four patients with hot nodes depicted by SPECT/CT and metastatic nodes were pathologically evident in the same lesion. Therefore, the present study indicated that the hot node in level II/III as depicted by SPECT/CT may be a risk of SN metastasis, including deeper nodes. PMID:25289038

SHIMA, HIROAKI; KUTOMI, GORO; SATOMI, FUKINO; MAEDA, HIDEKI; TAKAMARU, TOMOKO; KAMESHIMA, HIDEKAZU; OMURA, TOSEI; MORI, MITSURU; HATAKENAKA, MASAMITSU; HASEGAWA, TADASHI; HIRATA, KOICHI

2014-01-01

48

Imaging of esophageal cancer  

PubMed Central

Esophageal cancer is a relatively uncommon gastrointestinal malignancy but carries a poor prognosis unless it is of early stage and can be surgically resected for cure. Resectability is determined by the stage of disease at diagnosis and therefore accurate staging is of importance in patients diagnosed with esophageal cancer. Imaging studies that play a role in the evaluation of esophageal cancer include barium studies, computed tomography, endoscopic ultrasound and positron emission tomography. Imaging provides important information regarding the local extent and any distant spread of disease, which in turn helps in determining optimal management for these patients. This review discusses the imaging findings that may be encountered with various imaging modalities in the diagnosis, staging and follow-up of esophageal cancer. PMID:18250021

Iyer, R; DuBrow, R

2004-01-01

49

Esophageal cancer  

MedlinePLUS

Cancer - esophagus ... Esophageal cancer is not common in the United States. It occurs most often in men over 50 years old. There are two main types of esophageal cancer: squamous cell carcinoma and adenocarcinoma. These two types ...

50

Esophageal Cancer  

MedlinePLUS

... from your throat to your stomach. Early esophageal cancer usually does not cause symptoms. Later, you may ... You're at greater risk for getting esophageal cancer if you smoke, drink heavily, or have acid ...

51

SF 6432-CR (04-95) Sections II & III  

E-print Network

for Quotation and Contracts that Exceed $500,000 *F10 Contractor/Subcontractor Certified Cost 22 or Pricing Data1 SF 6432-CR (04-95) Sections II & III SECTION II STANDARD TERMS AND CONDITIONS FOR ALL COST of Labor Disputes 2 *A16 Contractor's Information 2 A17 Delegated Representatives 2 *A18 Defense Priority

52

Nimotuzumab combined with radiotherapy for esophageal cancer: preliminary study of a Phase II clinical trial  

PubMed Central

Objective To determine the safety and therapeutic effects of nimotuzumab (h-R3) combined with radiotherapy in esophageal cancer. Methods This Phase II clinical trial involved 42 patients with stage II (inoperable or refused surgery) to stage IV (supraclavicular lymph node metastasis only) esophageal cancers treated between November 2008 and July 2010. All patients had squamous cell carcinomas, and all received three-dimensional conformal radiotherapy and 200 mg nimotuzumab per week during radiotherapy. Results There were 9, 25, and 8 patients with stage II, III and IV disease, respectively. All except two patients received 50–70 Gy radiation; 37 patients (88.1%) received more than five nimotuzumab doses. Grade III toxicities (21.4% of all adverse events) included esophagitis and gastrointestinal, dermatological and hematological toxicities. Complete response, partial response, stable disease, and progressive disease were observed in 0, 22 (52.4%), 17 (40.5%) and 3 (7.1%) patients at 1 month after the treatment. The epidermal growth factor receptor (EGFR) overexpression rate was 95.2%. After a median follow-up of 37 months, the median survival time (MST) was 14 months. The 2 year and 3 year overall survival (OS) rates were 33.3% and 26.2%, respectively. The median progression-free survival (PFS) time was 10 months. The 2 year and 3 year PFS rates were 24.5% and 22.1%, respectively. The MST in the 13 patients with (+++) EGFR expression (group A) and 7 patients with (++) EGFR expression (group B) was 15 and 11 months, respectively. The 2 year and 3 year OS rates were 46.2% and 38.5% in group A and 28.6% and 28.6% in group B, respectively (P = 0.405). Conclusion Although concurrent chemoradiotherapy was the standard care for locally advanced esophageal cancer, radiotherapy was the choice for those who were refused or could not tolerate chemoradiotherapy. Our study shows that nimotuzumab combined with radiotherapy was well tolerated in patients with esophageal cancer. EGFR overexpression was more common than previously reported. OS was higher after combined therapy than after historical control radiotherapy alone. Further studies are required to confirm the therapeutic efficacy of nimotuzumab in esophageal cancer. PMID:24235844

Liang, Jun; E, Mingyan; Wu, Gang; Zhao, Lujun; Li, Xia; Xiu, Xia; Li, Ning; Chen, Bo; Hui, Zhouguang; Lv, Jima; Fang, Hui; Tang, Yu; Bi, Nan; Wang, Wenqing; Zhai, Yirui; Li, Tao; Chen, Dongfu; Zou, Shuangmei; Lu, Ning; Perez-Rodríguez, Rolando; Zheng, Junqi; Wang, Luhua

2013-01-01

53

Pilot Trial of CRLX101 in Treatment of Patients With Advanced or Metastatic Stomach, Gastroesophageal, or Esophageal Cancer That Cannot be Removed by Surgery  

ClinicalTrials.gov

Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Esophageal Cancer; Recurrent Gastric Cancer; Squamous Cell Carcinoma of the Esophagus; Stage IIIB Esophageal Cancer; Stage IIIB Gastric Cancer; Stage IIIC Esophageal Cancer; Stage IIIC Gastric Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer

2014-11-25

54

Pilot Trial of CRLX101 in Treatment of Patients With Advanced or Metastatic Stomach, Gastroesophageal, or Esophageal Cancer That Cannot be Removed by Surgery  

ClinicalTrials.gov

Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Esophageal Cancer; Recurrent Gastric Cancer; Squamous Cell Carcinoma of the Esophagus; Stage IIIB Esophageal Cancer; Stage IIIB Gastric Cancer; Stage IIIC Esophageal Cancer; Stage IIIC Gastric Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer

2015-02-02

55

[Histogenesis of human esophageal striated muscle tissue].  

PubMed

Development of the esophageal striated muscle tissue has been studied in 60 human embryos and fetuses at the age of 6-40 weeks. Stages in differentiation of the muscle fiber have been demonstrated, process of myofibrillogenesis has been studied. In the process of differentiation of the esophageal striated muscle fiber under the basal membrane myosatellitocytes are laid. A conclusion is made about myotomic origin of the human esophageal striated muscle tissue. The developmental peculiarity of the human esophageal striated muscle is formation between muscle fibers of specialized connections. This is explained by conditions of the esophageal functioning, that realizes peristaltic movements. PMID:2803022

Bazhenov, D V

1989-06-01

56

Expression of BAG-1 is closely related to cell differentiation and TNM stage in esophageal cancer and its downregulation inhibits the proliferation and invasion of human esophageal carcinoma cells.  

PubMed

The aim of the present study was to explore the correlation of BAG-1 with clinical characteristics of esophageal cancer and its effects on the proliferation, invasion and apoptosis of the esophageal carcinoma cell line Eca109. Therefore, the expression of BAG-1 was assessed in esophageal carcinoma tumor tissues and adjacent normal esophageal tissues. The siRNA vector of BAG-1 was constructed and transfected into the Eca109 cell line, and then fluorescence microscopy was used to evaluate the transfection efficiency. MTT and Transwell assays were used to study cell proliferation and invasive activity, and the apoptosis rate was assessed by flow cytometry. Western blotting was adopted to assess the silencing efficiency and expression of related gene bcl-2. The results revealed that BAG-1 expression was low in the adjacent normal esophageal tissues while expression was high in the esophageal carcinoma tissues. After Eca109 cells were transfected with BAG-1-siRNA, the proliferation and invasive capabilities of the cells were significantly decreased while the apoptosis rate was greatly enhanced (P<0.01). When the expression of BAG-1 in the Eca109 cells was downregulated, the expression of bcl-2 was significantly abated (P<0.05). In conclusion, BAG-1 is closely connected with the pathogenesis and development of esophageal carcinoma, which may act through affecting bcl-2. PMID:25069471

Huang, Bo; Zhou, Hongli; Lang, Xianping; Liu, Zhiliang; Xiong, Fei; Wang, Siwang

2014-10-01

57

Dietary habits and esophageal cancer.  

PubMed

Cancer of the esophagus is an underestimated, poorly understood, and changing disease. Its overall 5-year survival is less than 20%, even in the United States, which is largely a function of a delay in diagnosis until its more advanced stages. Additionally, the epidemiologic complexities of esophageal cancer are vast, rendering screening and prevention limited at best. First, the prevalence of esophageal cancer is unevenly distributed throughout the world. Second, the two histological forms (squamous cell and adenocarcinoma) vary in terms of their geographic prevalence and associated risk factors. Third, some populations appear at particular risk for esophageal cancer. And fourth, the incidence of esophageal cancer is in continuous flux among groups. Despite the varied prevalence and risks among populations, some factors have emerged as consistent associations while others are only now becoming more fully recognized. The most prominent, scientifically supported, and long-regarded risk factors for esophageal cancer are tobacco, alcohol, and reflux esophagitis. Inasmuch as the above are regarded as important risk factors for esophageal cancer, they are not the sole contributors. Dietary habits, nutrition, local customs, and the environment may be contributory. Along these lines, vitamins, minerals, fruits, vegetables, meats, fats, salted foods, nitrogen compounds, carcinogens, mycotoxins, and even the temperature of what we consume are increasingly regarded as potential etiologies for this deadly although potentially preventable disease. The goal of this review is to shed light on the less known role of nutrition and dietary habits in esophageal cancer. PMID:23795778

Palladino-Davis, A G; Mendez, B M; Fisichella, P M; Davis, C S

2015-01-01

58

Proton Beam Therapy and concurrent chemotherapy for esophageal cancer  

PubMed Central

Purpose/Objective Proton beam therapy (PBT) is a promising modality for the management of thoracic malignancies. We report our preliminary experience of treating esophageal cancer patients with concurrent chemotherapy (CChT) and PBT at MD Anderson Cancer Center. Materials/Methods This is an analysis of 62 esophageal cancer patients enrolled on a prospective study evaluating normal tissue toxicity from CChT/PBT from 2006 to 2010. Patients were treated with Passive Scattering PBT with 2 or 3 field beam arrangement using 180–250 MV protons. We used the method of Kaplan and Meier to assess time to event outcomes and compared the distributions between groups using the log-rank test. Results The median follow-up time was 20.1 months for survivors. The median age was 68 years (range 38–86). Most were males (82%), had adenocarcinomas (76%) and had stage II-III disease (84%). The median radiation dose was 50.4 Gray-Equivalence (Gy(RBE)) (range 36–57.6). The most common grade 2–3 acute toxicities from CChT/PBT were esophagitis (46.8%), fatigue (43.6%), nausea (33.9%), anorexia (30.1%), and radiation dermatitis (16.1%). There were two cases of grade 2 and 3 radiation pneumonitis and two grade 5 toxicities. A total of 29 patients (46.8%) received preoperative CChT/PBT with one postoperative death. The pathologic complete response (pCR) rate for the surgical cohort was 28%, and the pCR and near CR rate (0–1% residual cells) was 50%. While there were significantly fewer local-regional recurrences in the preoperative group (3/29) as compared to the definitive CChT/PBT group (16/33) (log-rank test p=0.005), there were no differences in DM free interval or OS between the two groups. Conclusions This is the first report of patients treated with PBT/CChT for esophageal cancer. Our data suggest that this modality is associated with a few severe toxicities but the pathologic response and clinical outcomes are encouraging. Prospective comparison with more traditional approach is warranted. PMID:22417808

Lin, Steven H.; Komaki, Ritsuko; Liao, Zhongxing; Wei, Caimiao; Myles, Bevan; Guo, Xiaomao; Palmer, Matthew; Mohan, Radhe; Swisher, Stephen G.; Hofstetter, Wayne L.; Ajani, Jaffer A.; Cox, James D.

2014-01-01

59

Proton Beam Therapy and Concurrent Chemotherapy for Esophageal Cancer  

SciTech Connect

Purpose: Proton beam therapy (PBT) is a promising modality for the management of thoracic malignancies. We report our preliminary experience of treating esophageal cancer patients with concurrent chemotherapy (CChT) and PBT (CChT/PBT) at MD Anderson Cancer Center. Methods and Materials: This is an analysis of 62 esophageal cancer patients enrolled on a prospective study evaluating normal tissue toxicity from CChT/PBT from 2006 to 2010. Patients were treated with passive scattering PBT with two- or three-field beam arrangement using 180 to 250 MV protons. We used the Kaplan-Meier method to assess time-to-event outcomes and compared the distributions between groups using the log-rank test. Results: The median follow-up time was 20.1 months for survivors. The median age was 68 years (range, 38-86). Most patients were males (82%) who had adenocarcinomas (76%) and Stage II-III disease (84%). The median radiation dose was 50.4 Gy (RBE [relative biologic equivalence]) (range, 36-57.6). The most common grade 2 to 3 acute toxicities from CChT/PBT were esophagitis (46.8%), fatigue (43.6%), nausea (33.9%), anorexia (30.1%), and radiation dermatitis (16.1%). There were two cases of grade 2 and 3 radiation pneumonitis and two cases of grade 5 toxicities. A total of 29 patients (46.8%) received preoperative CChT/PBT, with one postoperative death. The pathologic complete response (pCR) rate for the surgical cohort was 28%, and the pCR and near CR rates (0%-1% residual cells) were 50%. While there were significantly fewer local-regional recurrences in the preoperative group (3/29) than in the definitive CChT/PBT group (16/33) (log-rank test, p = 0.005), there were no differences in distant metastatic (DM)-free interval or overall survival (OS) between the two groups. Conclusions: This is the first report of patients treated with PBT/CChT for esophageal cancer. Our data suggest that this modality is associated with a few severe toxicities, but the pathologic response and clinical outcomes are encouraging. Prospective comparison with more traditional approach is warranted.

Lin, Steven H., E-mail: shlin@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Komaki, Ritsuko; Liao Zhongxing [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wei, Caimiao [Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Myles, Bevan [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Guo Xiaomao [Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China); Palmer, Matthew [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mohan, Radhe [Department of Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Swisher, Stephen G.; Hofstetter, Wayne L. [Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cox, James D. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

2012-07-01

60

Esophageal Stenosis Associated With Tumor Regression in Radiotherapy for Esophageal Cancer: Frequency and Prediction  

SciTech Connect

Purpose: To determine clinical factors for predicting the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. Methods and Materials: The study group consisted of 109 patients with esophageal cancer of T1-4 and Stage I-III who were treated with definitive radiotherapy and achieved a complete response of their primary lesion at Kyushu University Hospital between January 1998 and December 2007. Esophageal stenosis was evaluated using esophagographic images within 3 months after completion of radiotherapy. We investigated the correlation between esophageal stenosis after radiotherapy and each of the clinical factors with regard to tumors and therapy. For validation of the correlative factors for esophageal stenosis, an artificial neural network was used to predict the esophageal stenotic ratio. Results: Esophageal stenosis tended to be more severe and more frequent in T3-4 cases than in T1-2 cases. Esophageal stenosis in cases with full circumference involvement tended to be more severe and more frequent than that in cases without full circumference involvement. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. In the multivariate analysis, T stage, extent of involved circumference, and wall thickness of the tumor region were significantly correlated to esophageal stenosis (p = 0.031, p < 0.0001, and p = 0.0011, respectively). The esophageal stenotic ratio predicted by the artificial neural network, which learned these three factors, was significantly correlated to the actual observed stenotic ratio, with a correlation coefficient of 0.864 (p < 0.001). Conclusion: Our study suggested that T stage, extent of involved circumference, and esophageal wall thickness of the tumor region were useful to predict the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer.

Atsumi, Kazushige [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Arimura, Hidetaka [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Terashima, Kotaro [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Matsuki, Takaomi [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Ohga, Saiji; Yoshitake, Tadamasa; Nonoshita, Takeshi; Tsurumaru, Daisuke; Ohnishi, Kayoko; Asai, Kaori; Matsumoto, Keiji [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Nakamura, Katsumasa [Department of Radiology, Kyushu University Hospital at Beppu, Oita (Japan); Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)

2012-04-01

61

Esophageal Cancer  

MedlinePLUS

Español Esophageal Cancer Definition Cancer that forms in tissues lining the esophagus (the muscular tube through which food passes from the throat to ... Therapies Cancer Clinical Trials More Information Harms of Smoking and Health Benefits of Quitting Metastatic Cancer How ...

62

Esophageal culture  

MedlinePLUS

Culture - esophageal ... There, it is placed in a special dish (culture) and watched for the growth of bacteria, fungus, ... and Fordtran's Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management . 9th ed. Philadelphia, Pa: Elsevier Saunders; 2010:chap ...

63

Eosinophilic esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition where infiltration of eosinophils into the esophageal mucosa leads to symptoms of esophageal dysfunction. It has rapidly emerged as an important cause of upper GI morbidity in patients of all ages and is encountered in a substantial proportion of patients undergoing diagnostic upper endoscopy. This review discusses the clinical, endoscopic, and histologic features of EoE and presents the most recent guidelines for diagnosis of EoE. It describes selected diagnostic dilemmas including distinguishing EoE from gastroesophageal reflux disease and addressing the newly recognized clinical entity of proton pump inhibitor responsive esophageal eosinophilia. It also highlights evidence to support both pharmacologic and non-pharmacologic treatments, including topical corticosteroids, dietary elimination therapy, and endoscopic dilation. PMID:23452635

Dellon, Evan S.

2012-01-01

64

Everolimus and Combination Chemotherapy in Treating Patients With Metastatic Stomach or Esophageal Cancer  

ClinicalTrials.gov

Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Recurrent Esophageal Cancer; Recurrent Gastric Cancer; Stage IV Esophageal Cancer; Stage IV Gastric Cancer

2014-11-06

65

[Congenital esophageal atresia].  

PubMed

Current management of congenital esophageal atresia (CEA) is described on the basis of our experience and recent literatures. Primary repair for Gross C type CEA is performed as modern standard treatment in infants without high-risk factors such as associated severe cardiac anomaly and respiratory insufficiency. Surgical strategy depends on preoperative condition of the infant therefore preoperative full assessment of the infant is very important. In general, delayed primary repair or staged repair on CEA is selected for premature infants weighing less than 1,500 g and high-risk infants. Recently, primary repair has become an effective option in premature infants without high-risk factors. In long-gap CEA, gastrostomy and/or closure of tracheoesophageal fistula is performed initially. Esophagoesophagostomy is carried out after attempts to decrease gap length. Intraoperative esophageal elongation is required in some infants. However esophageal replacement should be selected if esophageal elongation fails is impossible due to hypogenesis of lower esophagus. Thoracoscopic primary repair was recently reported as a new optional treatment. This treatment will be able to decrease the damage on the thoracic wall. However this procedure should be adopted after very careful discussion because it is difficult to accomplish without very skillful endoscopic surgical technique. PMID:15362565

Amae, Shintaro; Hayashi, Yutaka

2004-07-01

66

Pulmonary Vein to Esophageal Fistula after Staged Hybrid Totally Thoracoscopic Surgical and Percutaneous Radiofrequency Catheter Ablation: A Case Report  

PubMed Central

A case of a fistula running from the pulmonary vein to the esophagus after a staged hybrid procedure combining total thoracoscopic ablation and percutaneous radiofrequency catheter ablation has not been reported previously. We describe such a case in a 37-year-old man who was successfully treated by surgery.

Park, Byung-Jo; Kim, Yong Han; Jeong, Dong Seop; Choi, Yong Soo; On, Young Keun

2014-01-01

67

An A/C germline single-nucleotide polymorphism in the TNFAIP3 gene is associated with advanced disease stage and survival in only surgically treated esophageal cancer.  

PubMed

Prognostication of disease relapse and survival is essential for cancer patients and genetic variations in cancer patients may serve as important indicators. A single-nucleotide polymorphism (SNP) mapping to the tumor necrosis factor, alpha-induced protein 3 (TNFAIP3) gene at position 138241110 displays three genotypes (AA, AC and CC). The aim of this study was to evaluate the potential prognostic value of the TNFAIP3-SNP in esophageal cancer (EC). Genomic DNA was extracted from peripheral blood leukocytes of 173 patients who underwent complete surgical resection for EC and did not receive any neoadjuvant or adjuvant therapy. For SNP detection, a 260- bp fragment was PCR amplified, purified and sequenced with tested primers. The product was analyzed by automatic DNA sequencer.The TNFAIP3 genotypes were correlated with clinico-pathological parameters, tumor cell dissemination in bone marrow and clinical outcome. The C-allele carrier presented with higher disease stage (P<0.001). This was predominantly because of the presence of lymph node metastasis (P<0.001). The recurrence rate was higher in C-allele carriers (AC and CC genotype; P=0.004). Kaplan-Meier plots for disease-free (P=0.017) and overall survival (P<0.001) displayed a gene dosage-associated outcome with AA genotype patients presenting the longest and CC genotype patients the poorest survival. In disease stage-adjusted multivariate analysis the TNFAIP3-SNP was identified as an independent prognostic factor for survival (hazard ratio 1.9; P=0.008). The TNFAIP3-SNP allows risk stratification of EC patients and may be a useful tool to identify patients eligible for multimodal therapy concepts. PMID:25354935

Ghadban, Tarik; Smif, Magdalena; Uzunoglu, Faik G; Perez, Daniel R; Tsui, Tung Y; El Gammal, Alexander T; Erbes, Peter J; Zilbermints, Veacheslav; Wellner, Ulrich; Pantel, Klaus; Izbicki, Jakob R; Vashist, Yogesh K

2014-12-01

68

Enantioselective Carbonyl-Ene Reactions Catalyzed by Chiral Cationic Dirhodium(II,III) Carboxamidates.  

PubMed

An enantioselective carbonyl-ene reaction of glyoxylate esters with 1,1-disubstituted alkenes catalyzed by chiral cationic dirhodium(II,III) carboxamidates is described. The paddlewheel dirhodium(II,III) carboxamidates having one open coordination site at each rhodium smoothly catalyze the carbonyl-ene reaction to afford homoallylic alcohol products in good isolated yields with high enantioselectivities. PMID:25084486

Xu, Xichen; Wang, Xiaochen; Liu, Yuxiao; Doyle, Michael P

2014-12-19

69

A Hybrid Geometric Phase II/III Clinical Trial Design based on Treatment Failure Time and Toxicity  

PubMed Central

The problem of comparing several experimental treatments to a standard arises frequently in medical research. Various multi-stage randomized phase II/III designs have been proposed that select one or more promising experimental treatments and compare them to the standard while controlling overall Type I and Type II error rates. This paper addresses phase II/III settings where the joint goals are to increase the average time to treatment failure and control the probability of toxicity while accounting for patient heterogeneity. We are motivated by the desire to construct a feasible design for a trial of four chemotherapy combinations for treating a family of rare pediatric brain tumors. We present a hybrid two-stage design based on two-dimensional treatment effect parameters. A targeted parameter set is constructed from elicited parameter pairs considered to be equally desirable. Bayesian regression models for failure time and the probability of toxicity as functions of treatment and prognostic covariates are used to define two-dimensional covariate-adjusted treatment effect parameter sets. Decisions at each stage of the trial are based on the ratio of posterior probabilities of the alternative and null covariate-adjusted parameter sets. Design parameters are chosen to minimize expected sample size subject to frequentist error constraints. The design is illustrated by application to the brain tumor trial design. PMID:22228921

Thall, Peter F.; Nguyen, Hoang Q.; Wang, Xuemei; Wolff, Johannes E.

2011-01-01

70

ARSENIC INTERACTION WITH IRON (II, III) HYDROXYCARBONATE GREEN RUST: IMPLICATIONS FOR ARSENIC REMEDIATION  

EPA Science Inventory

Zerovalent iron is being used in permeable reactive barriers (PRBs) to remediate groundwater arsenic contamination. Iron(II, III) hydroxycarbonate green rust is a major corrosion product of zerovalent iron under anaerobic conditions. The interaction between arsenic and this green...

71

Esophageal candidiasis in AIDS  

Microsoft Academic Search

In this paper we describe the results of oral therapy of esophageal candidiasis with clotrimazole vaginal tablets in 25 homosexual men with AIDS, of whom 19 had oral candidiasis and 16 had esophageal symptoms. Therapy with clotrimazole vaginal tablets, 100 mg, taken by mouth cleared the esophageal symptoms, oral candidiasis, and esophageal lesions completely in all 25 men. Clotrimazole vaginal

Eoin Lalor; Linda Rabeneck

1991-01-01

72

A Molecular Predictor Reassesses Classification of Human Grade II/III Gliomas  

PubMed Central

Diffuse gliomas are incurable brain tumors divided in 3 WHO grades (II; III; IV) based on histological criteria. Grade II/III gliomas are clinically very heterogeneous and their prognosis somewhat unpredictable, preventing definition of appropriate treatment. On a cohort of 65 grade II/III glioma patients, a QPCR-based approach allowed selection of a biologically relevant gene list from which a gene signature significantly correlated to overall survival was extracted. This signature clustered the training cohort into two classes of low and high risk of progression and death, and similarly clustered two external independent test cohorts of 104 and 73 grade II/III patients. A 22-gene class predictor of the training clusters optimally distinguished poor from good prognosis patients (median survival of 13–20 months versus over 6 years) in the validation cohorts. This classification was stronger at predicting outcome than the WHO grade II/III classification (P?2.8E-10 versus 0.018). When compared to other prognosis factors (histological subtype and genetic abnormalities) in a multivariate analysis, the 22-gene predictor remained significantly associated with overall survival. Early prediction of high risk patients (3% of WHO grade II), and low risk patients (29% of WHO grade III) in clinical routine will allow the development of more appropriate follow-up and treatments. PMID:23805239

Rème, Thierry; Bièche, Ivan; Rigau, Valérie; Burel-Vandenbos, Fanny; Prévot, Vincent; Baroncini, Marc; Fontaine, Denys; Chevassus, Hugues; Vacher, Sophie; Lidereau, Rosette; Duffau, Hugues

2013-01-01

73

Data-driven treatment selection for seamless phase II/III trials incorporating early-outcome data  

PubMed Central

Seamless phase II/III clinical trials are conducted in two stages with treatment selection at the first stage. In the first stage, patients are randomized to a control or one of k?>?1 experimental treatments. At the end of this stage, interim data are analysed, and a decision is made concerning which experimental treatment should continue to the second stage. If the primary endpoint is observable only after some period of follow-up, at the interim analysis data may be available on some early outcome on a larger number of patients than those for whom the primary endpoint is available. These early endpoint data can thus be used for treatment selection. For two previously proposed approaches, the power has been shown to be greater for one or other method depending on the true treatment effects and correlations. We propose a new approach that builds on the previously proposed approaches and uses data available at the interim analysis to estimate these parameters and then, on the basis of these estimates, chooses the treatment selection method with the highest probability of correctly selecting the most effective treatment. This method is shown to perform well compared with the two previously described methods for a wide range of true parameter values. In most cases, the performance of the new method is either similar to or, in some cases, better than either of the two previously proposed methods. © 2014 The Authors. Pharmaceutical Statistics published by John Wiley & Sons Ltd. PMID:24789367

Kunz, Cornelia Ursula; Friede, Tim; Parsons, Nick; Todd, Susan; Stallard, Nigel

2014-01-01

74

Eosinophilic esophagitis: the newest esophageal inflammatory disease  

Microsoft Academic Search

Eosinophilic esophagitis (EoE) is a chronic esophageal inflammatory disease of undetermined pathophysiology that results in dense mucosal eosinophilia and esophageal dysfunction. In childhood, vague symptoms associated with GERD and feeding difficulties are the first manifestations of EoE. Adults typically present with dysphagia and food impaction. No pathognomonic features have been identified for EoE and, therefore, its diagnosis must be made

Dan Atkins; Robert Kramer; Kelley Capocelli; Mark Lovell; Glenn T. Furuta

2009-01-01

75

Esophageal Dysmotility in patients with Eosinophilic Esophagitis  

PubMed Central

Summary The understanding of esophageal motility alterations in patients with eosinophilic esophagitis is in its infancy despite the common presenting complaint of dysphagia. A diversity of motility disorders has been reported in patients with EE including achalasia, diffuse esophageal spasm, nutcracker esophagus and non-specific motility alterations including high amplitude esophageal body contractions, tertiary contractions, LES pressure abnormalities and other peristaltic problems. Some evidence suggests that treatment of EE will result in some improvements in motility. The advent of technology such as high resolution manometry and combined manometry with impedance may provide new insight into more subtle motility abnormalities. PMID:18061103

Nurko, Samuel; Rosen, Rachel

2008-01-01

76

Esophageal stricture - benign  

MedlinePLUS

Benign esophageal stricture is a narrowing of the esophagus (the tube from the mouth to the stomach) that causes swallowing ... Esophageal stricture can be caused by: Gastroesophageal reflux (GERD) Injuries caused by an endoscope Long-term use of ...

77

Esophageal Cancer Prevention  

MedlinePLUS

... factors may increase the risk of esophageal cancer: Tobacco and alcohol use Squamous cell carcinoma of the ... may decrease the risk of esophageal cancer: Avoiding tobacco and alcohol use Many studies have shown that ...

78

Esophageal cancer: Recent advances in screening, targeted therapy, and management  

PubMed Central

The incidence of esophageal cancer remains on the rise worldwide and despite aggressive research in the field of gastrointestinal oncology, the survival remains poor. Much remains to be defined in esophageal cancer, including the development of an effective screening tool, identifying a good tumor marker for surveillance purposes, ways to target esophageal cancer stem cells as well as circulating tumor cells, and developing minimally invasive protocols to treat early-stage disease. The goal of this chapter is to highlight some of the recent advances and ongoing research in the field of esophageal cancer. PMID:25395880

Gaur, Puja; Kim, Min P.; Dunkin, Brian J.

2014-01-01

79

40 CFR 147.2650 - State-administered program-Class I, II, III, IV, and V wells.  

Code of Federal Regulations, 2010 CFR

...program-Class I, II, III, IV, and V wells. 147.2650 Section 147...Class I, II, III, IV, and V wells. The Underground Injection...Program for all classes of wells in the Commonwealth of...For information on the availability of this material at...

2010-07-01

80

CHEMICAL INTERACTIONS OF ARSENATE, ARSENITE, PHOSPHATE, AND SILICATE WITH IRON (II, III) HYDROXYCARBONATE GREEN RUST  

EPA Science Inventory

Granular zerovalent iron has been proposed to be used as a medium in permeable reactive barriers (PRBs) to remove arsenic from contaminated groundwater. Iron(II, III) hydroxycarbonate green rust (carbonate green rust, or CGR) is a major corrosion product of zerovalent iron under ...

81

CHEMICAL INTERACTIONS OF ARSENATE, ARSENITE, PHOSPHATE, AND SILICATE WITH IRON (II,III) HYDROXYCARBONATE GREEN RUST  

EPA Science Inventory

Granular zerovalent iron has been proposed to be used as a medium in permeable reactive barriers (PRBs) to remove arsenic from contaminated groundwater. Iron(II, III) hydroxycarbonate green rust (carbonate green rust, or CGR) is a major corrosion product of zerovalent iron under ...

82

ARSENATE AND ARSENITE SORPTION AND ARSENITE OXIDATION BY IRON (II, III) HYDROXYCARBONATE GREEN RUST  

EPA Science Inventory

Iron (II, III) hydroxycarbonate green rust is a major corrosion product of zerovalent iron that is being used in permeable reactive barriers to remediate groundwater arsenic contamination. To optimize the design of iron barriers, it is important to evaluate the influence of geoch...

83

Sustainable Practices Policy Sections II, III.I. and V.I. Sustainable Water Systems  

E-print Network

Sustainable Practices Policy Sections II, III.I. and V.I. ­ Sustainable Water Systems Revenue is Outpatient Revenue + Newborn Revenue + Inpatient Revenue. Domestic Water: Potable and non-potable water provided for domestic indoor (e.g., toilets, urinals, showers, and faucets) and outdoor (e

California at Santa Cruz, University of

84

[Advances in the research of scar stricture after esophageal burn].  

PubMed

Caustic esophageal burn is a common ailment in clinical practice. In some patients, scar stricture was formed in the late stage of injury, and it seriously undermined quality of life of the patients. We adopted various clinical interventions at an early stage in order to relieve and alleviate the formation and development of corrosive esophageal stricture as a result of chemical injury as well as to avoid invasive operations to make it more acceptable for the patients. This article summarized the progress in etiology, pathological changes, identification, early prevention, and surgical management of corrosive esophageal stricture. PMID:24360005

Zhao, Shi-lei; Gu, Chun-dong

2013-10-01

85

Diet and esophageal disease.  

PubMed

The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on macronutrients, dietary patterns, and risk of adenocarcinoma in Barrett's esophagus; micronutrients, trace elements, and risk of Barrett's esophagus and esophageal adenocarcinoma; the role of mate consumption in the development of squamous cell carcinoma; the relationship between energy excess and development of esophageal adenocarcinoma; and the nutritional management of the esophageal cancer patient. PMID:25266021

Dawsey, Sanford M; Fagundes, Renato B; Jacobson, Brian C; Kresty, Laura A; Mallery, Susan R; Paski, Shirley; van den Brandt, Piet A

2014-09-01

86

Esophageal duplication cyst.  

PubMed

Esophageal duplication cyst is a rare congenital mediastinal cyst. Most of these cysts become symptomatic in childhood and only rare cases remain asymptomatic until adolescence. They may produce symptoms due to esophageal and respiratory system compression, rupture, and infection. A 25-year-old man presented with pulmonary infection and bronchiectasis that did not improve with medical treatment. A diagnosis of esophageal duplication cyst was made intraoperatively. PMID:24757179

Bagheri, Reza; Asnaashari, Amir Mohammad Hashem; Afghani, Reza

2015-03-01

87

Magnetic chitosan\\/iron (II, III) oxide nanoparticles prepared by spray-drying  

Microsoft Academic Search

Chitosan\\/iron (II, III) oxide nanoparticles with various ratios of chitosan\\/iron (CS1\\/Fe4, CS2\\/Fe4 and CS3\\/Fe4) were prepared by a spray-drying method. Atomic absorption spectrometry (AAS), Fourier transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD) spectrometry data confirm that magnetic crystalline Fe3O4 interacts with chitosan and distributes in the chitosan matrix. Field emission scanning electron microscopy (FESEM) micrographs indicate that nanoparticles so

Hsin-Yi Huang; Yeong-Tarng Shieh; Chao-Ming Shih; Yawo-Kuo Twu

2010-01-01

88

Chemoprevention of esophageal squamous cell carcinoma  

SciTech Connect

Esophageal squamous cell carcinoma (SCC) is responsible for approximately one-sixth of all cancer-related mortality worldwide. This malignancy has a multifactorial etiology involving several environmental, dietary and genetic factors. Since esophageal cancer has often metastasized at the time of diagnosis, current treatment modalities offer poor survival and cure rates. Chemoprevention offers a viable alternative that could well be effective against the disease. Clinical investigations have shown that primary chemoprevention of this disease is feasible if potent inhibitory agents are identified. The Fischer 344 (F-344) rat model of esophageal SCC has been used extensively to investigate the biology of the disease, and to identify chemopreventive agents that could be useful in human trials. Multiple compounds that inhibit tumor initiation by esophageal carcinogens have been identified using this model. These include several isothiocyanates, diallyl sulfide and polyphenolic compounds. These compounds influence the metabolic activation of esophageal carcinogens resulting in reduced genetic (DNA) damage. Recently, a few agents have been shown to inhibit the progression of preneoplastic lesions in the rat esophagus into tumors. These agents include inhibitors of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF) and c-Jun [a component of activator protein-1 (AP-1)]. Using a food-based approach to cancer prevention, we have shown that freeze-dried berry preparations inhibit both the initiation and promotion/progression stages of esophageal SCC in F-344 rats. These observations have led to a clinical trial in China to evaluate the ability of freeze-dried strawberries to influence the progression of esophageal dysplasia to SCC.

Stoner, Gary D. [Division of Hematology and Oncology, Department of Internal Medicine, Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH 43210 (United States)], E-mail: gary.stoner@osumc.edu; Wang Lishu; Chen Tong [Division of Hematology and Oncology, Department of Internal Medicine, Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH 43210 (United States)

2007-11-01

89

Stomach-Esophageal Cancer  

Cancer.gov

Stomach and esophageal cancers are close in anatomical location and have been combined into one project within TCGA. Although they are two separate cancer types, TCGA is collecting samples from various anatomic subsites along the esophageal and gastric tracts for analysis.

90

Esophageal pH monitoring  

MedlinePLUS

pH monitoring - esophageal; Esophageal acidity test ... to stay in the hospital for the esophageal pH monitoring. ... Esophageal pH monitoring is used to check how much stomach acid is entering the esophagus. It also checks how ...

91

Esophageal endosclerosis in children.  

PubMed

During the past 6 years, 25 consecutive patients with esophageal variceal hemorrhage were treated by esophageal endosclerosis (direct injection of varices with a sclerosing agent). The primary disease in the 25 children was portal vein thrombosis (11 patients), biliary atresia (nine patients), and hepatic cirrhosis from cystic fibrosis (three patients), alpha 1-antitrypsin deficiency (one patient), and neonatal hepatitis (one patient). Thirteen patients were treated during acute, major variceal hemorrhage. Esophageal endosclerosis was repeated at regular intervals until all esophageal varices were obliterated. Twenty-one patients completed therapy. Four patients died: one of a complication of therapy and three of the primary disease. Other than the one death, complications were minor. Recurrent esophageal variceal hemorrhage has not been encountered in follow-up from 9 months to 6 years after completion of therapy. PMID:3877348

Stellen, G P; Lilly, J R

1985-11-01

92

Extraesophageal saline during endoscopic submucosal dissection in a patient with early esophageal squamous cell carcinoma.  

PubMed

Saline submucosal injection (SSI) is an indispensable procedure before endoscopic submucosal dissection (ESD) in patients with early esophageal squamous cell carcinoma. Successful SSI should create a saline cushion in the submucosa rather than elsewhere. However, saline outside the esophagus was detected incidentally by endoscopic ultrasonography during ESD in a patient with early esophageal cancer. In this case, saline separated the esophageal adventitia from adjacent tissues, and there were no complications during or after ESD. This finding indicates that it is possible to use interventional extraesophageal saline injection to help differentiate advanced esophageal cancer of Stage T3 from Stage T4 by endoscopic ultrasonography. PMID:25441804

Li, Jian-jun; Shan, Hong-bo; He, Long-jun; Luo, Guang-yu; Chen, Li-ming; Xu, Guo-liang; Li, Yin; Zhang, Rong

2014-11-01

93

Endoscopic assessment and management of early esophageal adenocarcinoma  

PubMed Central

Esophageal carcinoma affects more than 450000 people worldwide and the incidence is rapidly increasing. In the United States and Europe, esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence. Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages. Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett’s esophagus. These risk factors include chronic gastroesophageal reflux disease, hiatal hernia, advanced age, male sex, white race, cigarette smoking, and obesity. The annual risk of esophageal cancer is approximately 0.25% for patients without dysplasia and 6% for patients with high-grade dysplasia. Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa. The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option. The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia. Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation, photodynamic therapy and cryoablation. Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion. Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor, positive lymph node and submucosal invasion. Surgical resection should be offered to patients with deep submucosal invasion. PMID:25132925

Hammoud, Ghassan M; Hammad, Hazem; Ibdah, Jamal A

2014-01-01

94

Endoscopic assessment and management of early esophageal adenocarcinoma.  

PubMed

Esophageal carcinoma affects more than 450000 people worldwide and the incidence is rapidly increasing. In the United States and Europe, esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence. Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages. Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett's esophagus. These risk factors include chronic gastroesophageal reflux disease, hiatal hernia, advanced age, male sex, white race, cigarette smoking, and obesity. The annual risk of esophageal cancer is approximately 0.25% for patients without dysplasia and 6% for patients with high-grade dysplasia. Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa. The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option. The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia. Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation, photodynamic therapy and cryoablation. Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion. Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor, positive lymph node and submucosal invasion. Surgical resection should be offered to patients with deep submucosal invasion. PMID:25132925

Hammoud, Ghassan M; Hammad, Hazem; Ibdah, Jamal A

2014-08-15

95

Role of Natural Organic Matter in Regulating the Partitioning of Fe(II, III) in Seawater  

NASA Astrophysics Data System (ADS)

Iron (Fe) is an essential micronutrient and plays an important role in controlling ocean productivity and carbon cycling. Fe has been shown to be mostly complexed with dissolved organic matter in seawater. However, the interaction of Fe with natural organic matter and how the quality and quantity of organic matter affect the chemical speciation of Fe in seawater remain poorly understood. Controlled laboratory experiments have been conducted to examine the partitioning of Fe(II, III) between dissolved, colloidal and particulate phases using radiotracers, model organic compounds, and ultrafiltration. In natural seawater, Fe is mostly partitioned in the colloidal and particulate phases, resulting in a logKd value of 7.3 and a logKc of 6.1, respectively. On average, about 25% of dissolved Fe-55 was found in the <1 kDa fraction, 56% in the 1-10 kDa small colloidal fraction, 11% in the 10-100 kDa medium colloidal fraction, and 8% in the large colloidal fraction (100 kDa-0.4 ?m). In experimental treatments with extracellular polysaccharides, the partitioning of Fe(II, III) changed from mostly in the colloidal fraction to mostly in the <1 kDa truly dissolved fraction, with on average 67% in the <1 kDa, 13% in the 1-10 kDa, 4% in the 10-100 kDa, and 6% in the 100 kDa-0.4 ?m fraction. The increase in Fe(II, III) solubility in the presence of extracellular polysaccharides is hypothesized to be the result of Fe reduction from Fe(III), a more particle-reactive form, to Fe(II), a more soluble form, during its interactions with natural organic matter in seawater. This experimental result has important implications for the biogeochemical cycling of Fe(II, III) and other redox sensitive trace elements in the ocean. While the complexation of Fe with DOM could depress the bioavailability of Fe in seawater, the resultant Fe reduction may significantly enhance its solubility and bioavailability to marine organisms.

Guo, L.; Chen, M.; Roberts, K.; Santschi, P. H.

2008-12-01

96

[Transthoracic-transabdominal resection of esophageal carcinoma].  

PubMed

54 patients suffering from esophageal cancer have been treated in a period from 1990 to 1994. In 29 cases curative resection was possible, corresponding to a resection rate of 54%. Average age of resected patients was 62 years. According to pTNM-classification the stages T1 and T2 amounted to 45%, T3 and T4 to 55%. Lymphatic node metastases were discovered with an incidence of 55%. In patients treated conservatively more unfavourable stage distributions and increased rates of lymphatic node metastasis were shown. Transthoracal-transabdominal esophageal resection was preferred as curative management. Lethality amounted to 13.8%. In 3 of 4 lethal cases after resection autopsy confirmed absence of tumor. Lethal complications were two respiratory insufficiencies, one suture line dehiscence and one alcoholic delirium. Survival rates were calculated by life-table-method. We consider the transthoracal-transabdominal esophageal resection as an acceptable therapeutic option in esophageal cancer offering a real chance of enduring curing. PMID:9206910

Schröder, H; Trebing, G; Trebing, D

1997-01-01

97

Long-term esophageal function following repair of esophageal atresia.  

PubMed Central

Primary repair of esophageal atresia restores gastrointestinal continuity, but does not ensure normal esophageal function. To date 22 patients, six to 32 (average 15) years after repair of their esophageal atresias, have been evaluated by personal interview and esophageal manometrics and acid reflux testing. Previous barium swallow examinations had demonstrated varying degrees of anastomotic narrowing (12 patients), abnormal esophageal motor function (11 patients), gastroesophageal reflux (two patients), and hiatal hernia (one patient). Ten patients experience intermittent dysphagia for solid foods. Seven have typical symptoms of gastroesophageal reflux. Esophageal function tests including manometry and intraesophageal pH recording, have demonstrated varying abnormalities of esophageal motility in 21 patients and moderate to severe gastroesophageal reflux in 13. Two patients have required reconstruction of the esophagogastric junction for control of severe reflux esophagitis. The unexpected high incidence of gastroesophageal reflux in these patients, coupled with their abnormal esophageal motility which impairs normal acid clearing, renders them more prone to reflux esophagitis. Careful long-term evaluation for gastroesophageal reflux and its complications is indicated following primary repair of esophageal atresia. Evaluation of esophageal function with intraesophageal pressure and pH recordings is a far more sensitive indicator of esophageal physiology than the barium swallow examination. PMID:20856

Orringer, M B; Kirsh, M M; Sloan, H

1977-01-01

98

Cyclization of the Intrinsically Disordered ?1S Dihydropyridine Receptor II-III Loop Enhances Secondary Structure and in Vitro Function*  

PubMed Central

A key component of excitation contraction (EC) coupling in skeletal muscle is the cytoplasmic linker (II-III loop) between the second and third transmembrane repeats of the ?1S subunit of the dihydropyridine receptor (DHPR). The II-III loop has been previously examined in vitro using a linear II-III loop with unrestrained N- and C-terminal ends. To better reproduce the loop structure in its native environment (tethered to the DHPR transmembrane domains), we have joined the N and C termini using intein-mediated technology. Circular dichroism and NMR spectroscopy revealed a structural shift in the cyclized loop toward a protein with increased ?-helical and ?-strand structure in a region of the loop implicated in its in vitro function and also in a critical region for EC coupling. The affinity of binding of the II-III loop binding to the SPRY2 domain of the skeletal ryanodine receptor (RyR1) increased 4-fold, and its ability to activate RyR1 channels in lipid bilayers was enhanced 3-fold by cyclization. These functional changes were predicted consequences of the structural enhancement. We suggest that tethering the N and C termini stabilized secondary structural elements in the DHPR II-III loop and may reflect structural and dynamic characteristics of the loop that are inherent in EC coupling. PMID:21525002

Tae, Han-Shen; Cui, Yanfang; Karunasekara, Yamuna; Board, Philip G.; Dulhunty, Angela F.; Casarotto, Marco G.

2011-01-01

99

Esophageal Chest Pain  

Microsoft Academic Search

\\u000a Esophageal chest pain has come under critical scrutiny recently [1]. Motility disorders in particular have fallen out of favor as a cause of chest pain [1–3], to the extent that chest pain of uncertain origin has now become a rare indication for esophageal manometry in the United\\u000a States [4]. The reasons for this include changing perceptions about the relevance of

John S de Caestecker

100

The history of lymphadenectomy for esophageal cancer and the future prospects for esophageal cancer surgery.  

PubMed

I would herein like to look back upon surgery for esophageal cancer, particularly on lymphadenectomy, and to speculate a little on the future prospects for esophageal surgery. There are two schools of thought on lymphadenectomy in esophageal cancer: one believes in en bloc esophagectomy, which is commonly performed in Western countries; the other believes in three-field lymphadenectomy, which is commonly performed in Japan. We esophageal surgeons at Kurume University have contributed to some advances in three-field lymphadenectomy. For example, we initiated functional mediastinal dissection to ensure patient safety, and we proposed the lymph node compartment theory to assess the clinical importance of regional nodes. Oncological surgery has progressed in terms of its safety, radicality and functional preservation, leading to improved quality-of-life for patients after surgery. This then evolved to the current development of multimodal and individualized tailor-made treatments. I believe that surgery for esophageal cancer will become bipolarized in the future. One strand will evolve as salvage surgery for residual or recurrent tumors, which non-surgical therapies have failed to cure, and the other strand will evolve as less invasive surgery, adjuvant surgery, for cancers at the relatively early stage, for which micro-metastasis can be cured by non-surgical therapies. PMID:24519395

Fujita, Hiromasa

2015-02-01

101

Current management of esophageal cancer  

PubMed Central

Management of esophageal cancer has evolved since the two last decades. Esophagectomy remains the primary treatment for early stage esophageal cancer although its specific role in superficial cancers is still under debate since the development of endoscopic mucosal treatment. To date, there is strong evidence to consider that locally advanced cancers should be recommended for a multimodal treatment with a neoadjuvant chemotherapy or a combined chemoradiotherapy (CRT) followed by surgery. For locally advanced squamous cell carcinoma or for a part of adenocarcinoma, some centers have proposed treating with definitive CRT to avoid related-mortality of surgery. In case of persistent or recurrent disease, a salvage esophagectomy remains a possible option but this procedure is associated with higher levels of perioperative morbidity and mortality. Despite the debate over what constitutes the best surgical approach (transthoracic versus transhiatal), the current question is if a minimally procedure could reduce the periopertive morbidity and mortality without jeopardizing the oncological results of surgery. Since the last decade, minimally invasive esophagectomy (MIE) or hybrid operations are being done in up to 30% of procedures internationally. There are some consistent data that MIE could decrease the incidence of the respiratory complications and decrease the length of hospital-stay. Nowadays, oncologic outcomes appear equivalent between open and minimally invasive procedures but numerous phase III trials are ongoing. PMID:24868443

Thomas, Pascal Alexandre

2014-01-01

102

Surgical indications and optimization of patients for resectable esophageal malignancies  

PubMed Central

Esophageal cancer is a devastating diagnosis with very dire long-term survival rates. This is largely due to its rather insidious progression, which leads to most patients being diagnosed with advanced disease. Recently, however, a greater understanding of the pathogenesis of esophageal malignancies has afforded surgeons and oncologists with new opportunities for intervention and management. Coupled with improvements in imaging, staging, and medical therapies, surgeons have continued to enhance their knowledge of the nuances of esophageal resection, which has resulted in the development of minimally invasive approaches with similar overall oncologic outcomes. This marriage of more efficacious induction therapy and diminished morbidity after esophagectomy offers new promise to patients diagnosed with this aggressive form of cancer. The following review will highlight these most recent advances and will offer insight into our own approach to patients with resectable esophageal malignancy. PMID:24624289

Grimm, Joshua C.; Valero, Vicente

2014-01-01

103

The sternocleidomastoid myocutaneous "patch esophagoplasty" for cervical esophageal stricture.  

PubMed

Esophageal strictures may be caused by many etiologies. Patients suffer from dysphagia and many are tube-feed dependent. Cervical esophageal reconstruction is challenging for the plastic surgeon, and although there are reports utilizing chest wall flaps or even free flaps, the use of a sternocleidomastoid (SCM) myocutaneous flap provides an ideal reconstruction in select patients who require noncircumferential "patch" cervical esophagoplasty. We present two cases of esophageal reconstruction in which we demonstrate our technique for harvesting and insetting the SCM flap, with particular emphasis on design of the skin paddle and elucidation of the vascular anatomy. We believe that the SCM flap is simple, reliable, convenient, and technically easy to perform. There is minimal donor site morbidity with no functional loss. The SCM myocutaneous flap is a viable option for reconstructing partial esophageal defects and obviates the need to perform staged procedures or more extensive operations such as free tissue transfer. PMID:21500276

Noland, Shelley S; Ingraham, John M; Lee, Gordon K

2011-05-01

104

Synthesis and electrocatalytic activity of haemin-functionalised iron(II, III) oxide nanoparticles.  

PubMed

Haemin-functionalised magnetic iron(II, III) oxide (Fe3O4) nanoparticles (Fe3O4/haemin) were synthesised by changing the acidity of a solution of the two compounds. The nanoparticles were characterised by transmission electron microscopy, UV-vis absorption spectroscopy, X-ray diffraction, Fourier transform infrared spectroscopy, measurement of magnetisation, and electrochemical techniques. The properties of both haemin and Fe3O4 were retained. Thus, Fe3O4/haemin nanoparticles exhibited pronounced electrocatalytic activity towards trichloroacetic acid (TCA) like haemin itself. Interestingly, electrocatalytic activity towards TCA was affected by detection temperature, which was controlled via electrically heated carbon paste electrodes. The maximal catalytic current was 5.8 times higher at 60°C than at room temperature (25°C). This proposed electrochemical sensor for TCA possessed a linear detection range of 5-80 ?M and a detection limit of 0.3 ?M at 60°C. PMID:23684464

Yin, Zheng-Zhi; Li, Yongjie; Jiang, Li-Ping; Rana, Rohit Kumar; Zhu, Jun-Jie

2013-06-01

105

Silencing DACH1 promotes esophageal cancer growth by inhibiting TGF-? signaling.  

PubMed

Human Dachshund homologue 1 (DACH1) is a major component of the Retinal Determination Gene Network. Loss of DACH1 expression was found in breast, prostate, lung, endometrial, colorectal and hepatocellular carcinoma. To explore the expression, regulation and function of DACH1 in human esophageal cancer, 11 esophageal cancer cell lines, 10 cases of normal esophageal mucosa, 51 cases of different grades of dysplasia and 104 cases of primary esophageal squamous cancer were employed. Methylation specific PCR, immunohistochemistry, western blot, flow cytometry, small interfering RNAs, colony formation techniques and xenograft mice model were used. We found that DACH1 expression was regulated by promoter region hypermethylation in esophageal cancer cell lines. 18.8% (6 of 32) of grade 1, 42.1% (8 of 19) of grade 2 and grade 3 dysplasia (ED2,3), and 61.5% (64 of 104) of esophageal cancer were methylated, but no methylation was found in 10 cases of normal esophageal mucosa. The methylation was increased in progression tendency during esophageal carcinogenesis (P<0.01). DACH1 methylation was associated with poor differentiation (P<0.05) and late tumor stage (P<0.05). Restoration of DACH1 expression inhibited cell growth and activated TGF-? signaling in KYSE150 and KYSE510 cells. DACH1 suppressed human esophageal cancer cell tumor growth in xenograft mice. In conclusion, DACH1 is frequently methylated in human esophageal cancer and methylation of DACH1 is involved in the early stage of esophageal carcinogenesis. DACH1 expression is regulated by promoter region hypermethylation. DACH1 suppresses esophageal cancer growth by activating TGF-? signaling. PMID:24743895

Wu, Liang; Herman, James G; Brock, Malcolm V; Wu, Kongming; Mao, Gaoping; Yan, Wenji; Nie, Yan; Liang, Hao; Zhan, Qimin; Li, Wen; Guo, Mingzhou

2014-01-01

106

Silencing DACH1 Promotes Esophageal Cancer Growth by Inhibiting TGF-? Signaling  

PubMed Central

Human Dachshund homologue 1 (DACH1) is a major component of the Retinal Determination Gene Network. Loss of DACH1 expression was found in breast, prostate, lung, endometrial, colorectal and hepatocellular carcinoma. To explore the expression, regulation and function of DACH1 in human esophageal cancer, 11 esophageal cancer cell lines, 10 cases of normal esophageal mucosa, 51 cases of different grades of dysplasia and 104 cases of primary esophageal squamous cancer were employed. Methylation specific PCR, immunohistochemistry, western blot, flow cytometry, small interfering RNAs, colony formation techniques and xenograft mice model were used. We found that DACH1 expression was regulated by promoter region hypermethylation in esophageal cancer cell lines. 18.8% (6 of 32) of grade 1, 42.1% (8 of 19) of grade 2 and grade 3 dysplasia (ED2,3), and 61.5% (64 of 104) of esophageal cancer were methylated, but no methylation was found in 10 cases of normal esophageal mucosa. The methylation was increased in progression tendency during esophageal carcinogenesis (P<0.01). DACH1 methylation was associated with poor differentiation (P<0.05) and late tumor stage (P<0.05). Restoration of DACH1 expression inhibited cell growth and activated TGF-? signaling in KYSE150 and KYSE510 cells. DACH1 suppressed human esophageal cancer cell tumor growth in xenograft mice. In conclusion, DACH1 is frequently methylated in human esophageal cancer and methylation of DACH1 is involved in the early stage of esophageal carcinogenesis. DACH1 expression is regulated by promoter region hypermethylation. DACH1 suppresses esophageal cancer growth by activating TGF-? signaling. PMID:24743895

Wu, Liang; Herman, James G.; Brock, Malcolm V.; Wu, Kongming; Mao, Gaoping; Yan, Wenji; Nie, Yan; Liang, Hao; Zhan, Qimin; Li, Wen; Guo, Mingzhou

2014-01-01

107

Vibrational-Exciton Couplings for the Amide I, II, III, and A Modes of Peptides Tomoyuki Hayashi and Shaul Mukamel*  

E-print Network

Vibrational-Exciton Couplings for the Amide I, II, III, and A Modes of Peptides Tomoyuki Hayashi and their overtones and combination vibrational states are calculated. Combined with the level energies reported effective vibrational Hamiltonian for the entire amide system. Couplings between neighboring peptide units

Mukamel, Shaul

108

Liver regeneration in living-related donors after harvesting of liver segments II and III or II, III and IV  

PubMed Central

Background CT-assisted volumetry permits an estimation of the volume of the graft in liver transplantation, as well as monitoring the donor's liver regeneration. The aim of the study was to observe the restitution of liver tissue in donors after harvesting of the liver fragment for living-related liver transplantation (LRLT). Methods The size of the whole liver and of segments II, III and IV was assessed by preoperative CT volumetry in 29 living-related liver donors. Segments II and III were harvested in 22 patients, segments II, III and IV in 6 patients. The remnant liver was assessed by CT volumetry on the 7th and 30th postoperative days. Results The correlation between the calculated volume of the graft and its weight was linear (r=0.56, p<0.04). Postoperative CT volumetry of the liver of living-related donors showed a different pattern of volume restoration (regeneration index) at both 7 and 30 days between donors who sacrificed segments II and III and those who sacrificed segments II, III and IV. The mean regeneration indexes were significantly higher in donors of segments II, III and IV as compared with donors of segments II and III (7 days, p<0.02; 30 days, p<0.05). Discussion It is possible that the donor's liver displays a different pattern of growth due to the alteration in blood supply to segment IV. PMID:18332975

Paluszkiewicz, R; Pacho, R; Hevelke, P; Zieniewicz, K; Grzelak, I; Najnigier, B; Kosi?ski, C; Paczkowska, A; Michalak, M; Leowska, E; Kalici?ski, P; Kami?ski, A; Pawtowska, J

2003-01-01

109

Concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil (5-FU) and cisplatin for locally advanced resectable esophageal cancer  

PubMed Central

Background Neoadjuvant concurrent chemoradiotherapy (CCRT) has become the standard treatment for esophageal cancer (EC) in North America. The cisplatin/5-flurouracil (5-FU) combination has been the most commonly used regimen. For the last 15 years we incorporated a daily continuous infusion of 5-FU and 2 doses of cisplatin into our neoadjuvant CCRT for potentially resectable EC. Patients and methods Between July 1997 and June 2012, 129 patients with locally advanced EC (T3 or N1 and higher), received neoadjuvant CCRT with cisplatin 75 mg/m2 on day 1 and day 29 and continuous infusion of 5-FU (225 mg/m2/day) on the days of radiation. Results The median age of patients was 63 years, 85% had adenocarcinoma, 29, 74 and 26 patients had stage II, III and IVa disease respectively, 110 patients had N1 disease based on the American Joint Committee on Cancer (AJCC) 6th edition, 118 patients experienced weight loss during treatment. All patients completed treatment. Treatment was well tolerated with 14% of patients having ? grade 3 toxicity and 18 patients requiring hospital admission. Sixty-four percent of patients had surgical resection following CCRT, with disease progression and patient refusal being the most common reasons for not proceeding with surgery. An R0 resection was achieved in 96% of patients. A pathological complete response (pCR) was achieved in 45% of patients. With a median follow up of 26 months (1.2-144 months), 48/129 patients recurred and 60/129 died of their disease. Conclusions Our study has its limitation, however, and compared to the conventional chemotherapy regimens containing the cisplatin/5-FU doublet, our treatment strategy for locally advanced EC CCRT seems to be feasible and well tolerated. PMID:25642336

Hoffe, Sarah; Strosberg, Jonathan; Dinwoodie, William; Meredith, Kenneth; Shridhar, Ravi

2015-01-01

110

Epiphrenic esophageal diverticula  

PubMed Central

Epiphrenic esophageal diverticula (EED) are rare. The estimated incidence is about 1:500,000/year. EED usually result from a combination of esophageal obstruction, functional or mechanical and a point of weakness of the muscularis propria. Most of the symptoms are unspecific, but dysphagia is most common. Chest radiograph, barium esophagogram, endoscopy and manometry are diagnostic tools. The treatment methods are conservative medical therapy, myotomy, diverticulectomy and fundoplication. In addition, endoscopic pneumatic dilation and botulinum toxin injection are a good alternative for symptomatic patients with motility disorders who are unfit for or unwilling to undergo surgery. PMID:25422668

Abdollahimohammad, Abdolghani; Masinaeinezhad, Nosratollah; Firouzkouhi, Mohammadreza

2014-01-01

111

Anorectal Malformations Associated with Esophageal Atresia in Neonates  

PubMed Central

Purpose Anorectal malformations are often associated with other anomalies, reporting frequency with 40-70%. Gastrointestinal anomalies have been known to be relatively less common than associated anomalies of other organ system. This study was performed to assess a distinctive feature of cases associated with esophageal atresia. Methods Clinical data (from January 2000 through December 2011) on the 196 subjects with anorectal malformations, managed in our Hospital, were reviewed. Total 14 neonates were identified with accompanying esophageal atresia and retrospective analysis was conducted. Results The incidence was 7.1% and there were 8 male and 6 female subjects. Only 2 cases were associated with esophageal atresia without tracheoesophageal fistula. Although variable cases of anorectal malformation in female subjects, almost cases were anorectal malformations with rectourethral fistula in male. Other associated anomalies were identified in all cases, with more than 3 anomalies in 10 cases. There were 4 VACTERL (Vertebral abnormalities, Anal atresia, Cardiac anomalies, Tracheoesophageal fistula, Esophageal atresia, Renal and Limb anomalies) associations accounting for 28.6%, but could not identify chromosomal anomaly. Most cases were managed with staged procedure, usually primary repair of esophageal atresia and diverting colostomy. Overall mortality rate was 21.4%, mainly caused by heart problems. Conclusion This study shows that early diagnosis and rational surgical approach with multidisciplinary plan are mandatory in managing anorectal malformations with esophageal atresia, when considering a high frequency of associated anomaly and a relative high mortality. PMID:24010103

Byun, Shin Yun; Lim, Ryoung Kyoung; Park, Kyung Hee; Kim, Hae Young

2013-01-01

112

Esophageal Rings and Webs  

MedlinePLUS

... determine if you have a ring or a web, your doctor may order one of these tests: Barium swallow test. This allows the radiologist to ... contribute to the development of esophageal rings and webs, your doctor probably will order a blood test for iron levels and, if you are deficient, ...

113

Tracheo-esophageal fistula: Successful palliation after failed esophageal stent  

PubMed Central

The incidence of tracheo-esophageal (TO) fistula is on the rise, especially after palliative management for esophageal malignancies. We report a case of cancer of esophagus who after chemotherapy and radiotherapy developed TO fistula. Placement of an esophageal stent helped him in taking food orally, but his cough and dyspnoea continued to worsen. Fibreoptic bronchoscopy demonstrated a severely compressed trachea secondary to protrusion of esophageal stent which responded very well to an Ultraflex-covered tracheal stent and the patient achieved relief from cough and dyspnoea. PMID:22919174

Chawla, Rakesh K.; Madan, Arun; Chawla, Kiran

2012-01-01

114

Tracheo-esophageal fistula: Successful palliation after failed esophageal stent.  

PubMed

The incidence of tracheo-esophageal (TO) fistula is on the rise, especially after palliative management for esophageal malignancies. We report a case of cancer of esophagus who after chemotherapy and radiotherapy developed TO fistula. Placement of an esophageal stent helped him in taking food orally, but his cough and dyspnoea continued to worsen. Fibreoptic bronchoscopy demonstrated a severely compressed trachea secondary to protrusion of esophageal stent which responded very well to an Ultraflex-covered tracheal stent and the patient achieved relief from cough and dyspnoea. PMID:22919174

Chawla, Rakesh K; Madan, Arun; Chawla, Kiran

2012-07-01

115

XAF1 is frequently methylated in human esophageal cancer  

PubMed Central

AIM: To explore epigenetic changes in the gene encoding X chromosome-linked inhibitor of apoptosis-associated factor 1 (XAF1) during esophageal carcinogenesis. METHODS: Methylation status of XAF1 was detected by methylation-specific polymerase chain reaction (MSP) in four esophageal cancer cell lines (KYSE30, KYSE70, BIC1 and partially methylated in TE3 cell lines), nine cases of normal mucosa, 72 cases of primary esophageal cancer and matched adjacent tissue. XAF1 expression was examined by semi-quantitative reverse transcriptional polymerase chain reaction and Western blotting before and after treatment with 5-aza-deoxycytidine (5-aza-dc), a demethylating agent. To investigate the correlation of XAF1 expression and methylation status in primary esophageal cancer, immunohistochemistry for XAF1 expression was performed in 32 cases of esophageal cancer and matched adjacent tissue. The association of methylation status and clinicopathological data was analyzed by logistic regression. RESULTS: MSP results were as follows: loss of XAF1 expression was found in three of four esophageal cell lines with promoter region hypermethylation (completely methylated in KYSE30, KYSE70 and BIC1 cell lines and partially in TE3 cells); all nine cases of normal esophageal mucosa were unmethylated; and 54/72 (75.00%) samples from patients with esophageal cancer were methylated, and 25/72 (34.70%) matched adjacent tissues were methylated (75.00% vs 34.70%, ?2 = 23.5840, P = 0.000). mRNA level of XAF1 measured with semi-quantitative reverse transcription polymerase chain reaction was detectable only in TE3 cells, and no expression was detected in KYSE30, KYSE70 or BIC1 cells. Protein expression was not observed in KYSE30 cells by Western blotting before treatment with 5-aza-dc. After treatment, mRNA level of XAF1 was detectable in KYSE30, KYSE70 and BIC1 cells. Protein expression was detected in KYSE30 after treatment with 5-aza-dc. Immunohistochemistry was performed on 32 cases of esophageal cancer and adjacent tissue, and demonstrated XAF1 in the nucleus and cytoplasm. XAF1 staining was found in 20/32 samples of adjacent normal tissue but was present in only 8/32 samples of esophageal cancer tissue (?2= 9.143, P = 0.002). XAF1 expression was decreased in cancer samples compared with adjacent tissues. In 32 cases of esophageal cancer, 24/32 samples were methylated, and 8/32 esophageal cancer tissues were unmethylated. XAF1 staining was found in 6/8 samples of unmethylated esophageal cancer and 2/24 samples of methylated esophageal cancer tissue. XAF1 staining was inversely correlated with XAF1 promoter region methylation (Fisher’s exact test, P = 0.004). Regarding methylation status and clinicopathological data, no significant differences were found in sex, age, tumor size, tumor stage, or metastasis with respect to methylation of XAF1 for the 72 tissue samples from patients with esophageal cancer. CONCLUSION: XAF1 is frequently methylated in esophageal cancer, and XAF1 expression is regulated by promoter region hypermethylation. PMID:22719195

Chen, Xiang-Yu; He, Qiao-Yu; Guo, Ming-Zhou

2012-01-01

116

Equatorial ?-stacking interactions in diruthenium (II,III) tetracarboxylate complexes containing extended ?-systems  

NASA Astrophysics Data System (ADS)

The synthesis of three new valent-averaged tetracarboxylatodiruthenium (II,III) complexes, [Ru2(1-naphthylacetate)4(H2O)2](PF6)?4THF, 1?4THF, [Ru2(2-naphthoate)4(THF)2](PF6)?3THF, 2?3THF, and [Ru2(coumarin-3-carboxylate)4(MeOH)2](PF6)?MeOH?H2O, 3?MeOH?H2O, was accomplished using a well documented carboxylate exchange reaction. All three complexes were thoroughly characterized using infrared and UV-Vis spectroscopies, elemental analysis and X-ray diffraction. Due to the extended ?-systems present, two of the complexes, 2?3THF and 3?MeOH?H2O, display extensive ?-stacking in two dimensions, with similar interactions notably absent in 1?4THF due to the perpendicular orientation of the naphthyl rings. Modest H-bonding is seen in complexes 1?4THF and 3?MeOH?H2O. As these types of complexes are noted secondary building units (SBU's) in the construction of metal-organic frameworks (MOF's), the significance of these interactions in stabilizing even larger, supramolecular structures, are noted.

O'Rourke, Natasha F.; Ronaldson, Michael; Stanley Cameron, T.; Wang, Ruiyao; Aquino, Manuel A. S.

2013-11-01

117

ROTATION OF THE K3 II-III GIANT STAR {alpha} HYDRA  

SciTech Connect

Fundamental spectroscopic determination of projected rotation rates of slowly rotating stars is challenging because the rotational broadening of the spectral lines is often comparable to, or smaller than, the broadening from other sources, most notably macroturbulence. Fourier techniques have the advantage over direct profile matching when the observed profiles are complete, but when the profiles are severely blended, the Fourier analysis is compromised. A process of modeling partial profiles for determining the rotation rate for stars having blended spectral lines is investigated and applied to the evolved star {alpha} Hya (K3 II-III). Projected rotation higher than 5 km s{sup -1} can be definitively ruled out for this star. Not all lines are equally good, depending on the amount of blending and also depending on the strength of the line, as the balance between the thermal and non-thermal components changes. A modest ambiguity arises between macroturbulence and rotational broadening, but a careful look at the differences between the observations and the models allows one to measure the rotation with acceptable precision. The result for {alpha} Hya is v sin i = 2.6 {+-} 0.3 km s{sup -1}.

Gray, David F., E-mail: dfgray@uwo.ca [Department of Physics and Astronomy, University of Western Ontario, London, Ontario (Canada)

2013-08-01

118

An Overview of Eosinophilic Esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease affecting both children and adults. The condition is characterized by an eosinophilic infiltration of the esophageal epithelium. Symptoms of esophageal dysfunction include dysphagia, food impaction and symptoms mimicking gastroesophageal reflux disease. Endoscopic examination typically reveals mucosal fragility, ring or corrugated mucosa, longitudinal furrows, whitish plaques or a small caliber esophagus. Histologic findings of >15 eosinophils per high-power field is the diagnostic hallmark of EoE. An elimination diet, topical corticosteroids or endoscopic dilation for fibrostenotic disease serve as effective therapeutic option. PMID:25368745

Park, Hyojin

2014-01-01

119

Esophageal cancer, early disease: Diagnosis and current treatment  

Microsoft Academic Search

Most esophageal cancers are at a fairly advanced stage at the time of diagnosis, and curative therapy is not possible. For those that are detected early, cure may be possible, particularly if there is no lymphatic spread. Radical therapeutic approaches result in increased treatmentrelated mortality, high treatment-induced morbidity, and reduced quality of life. Therefore it is one of the major

Horst Dieter Becker

1994-01-01

120

Apolipophorin II\\/I, Apolipoprotein B, Vitellogenin, and Microsomal Triglyceride Transfer Protein Genes Are Derived from a Common Ancestor  

Microsoft Academic Search

.   Large lipid transfer proteins (LLTP) are nonexchangeable apolipoproteins and intracellular lipid-exchange proteins involved\\u000a in the assembly, secretion, and metabolism of lipoproteins. We have identified contiguous conserved sequence motifs in alignments\\u000a of insect apolipophorin II\\/I precursor (apoLp-II\\/I), human apolipoprotein B (apoB), invertebrate and vertebrate vitellogenins\\u000a (VTG), and the large subunit of mammalian microsomal triglyceride transfer protein (MTP). Conserved motifs present

Patrick J. Babin; Jan Bogerd; Frank P. Kooiman; Wil J. A. Van Marrewijk; Dick J. Van der Horst

1999-01-01

121

Cux1 and Cux2 selectively target basal and apical dendritic compartments of layer II-III cortical neurons.  

PubMed

A number of recent reports implicate the differential regulation of apical and basal dendrites in autism disorders and in the higher functions of the human brain. They show that apical and basal dendrites are functionally specialized and that mechanisms regulating their development have important consequences for neuron function. The molecular identity of layer II-III neurons of the cerebral cortex is determined by the overlapping expression of Cux1 and Cux2. We previously showed that both Cux1 and Cux2 are necessary and nonredundant for normal dendrite development of layer II-III neurons. Loss of function of either gene reduced dendrite arbors, while overexpression increased dendritic complexity and suggested additive functions. We herein characterize the function of Cux1 and Cux2 in the development of apical and basal dendrites. By in vivo loss and gain of function analysis, we show that while the expression level of either Cux1 or Cux2 influences both apical and basal dendrites, they have distinct effects. Changes in Cux1 result in a marked effect on the development of the basal compartment whereas modulation of Cux2 has a stronger influence on the apical compartment. These distinct effects of Cux genes might account for the functional diversification of layer II-III neurons into different subpopulations, possibly with distinct connectivity patterns and modes of neuron response. Our data suggest that by their differential effects on basal and apical dendrites, Cux1 and Cux2 can promote the integration of layer II-III neurons in the intracortical networks in highly specific ways. © 2014 Wiley Periodicals, Inc. Develop Neurobiol 75: 163-172, 2015. PMID:25059644

Cubelos, Beatriz; Briz, Carlos G; Esteban-Ortega, Gemma María; Nieto, Marta

2015-02-01

122

Esophageal and Gastric Injuries  

Microsoft Academic Search

\\u000a Traumatic lesions of the esophagus can be classified into. Primary lesions, Perforations, Ruptures, Secondary lesions, Fistulas,\\u000a Strictures Perforations: Perforations are due to internal or external forces. The vast majority of esophageal perforations\\u000a occur iatrogenic (e.g., endoscopy, dilatation, transesophageal echocardiography (TEE), Sengstaken–Blakemore tubes, endotracheal\\u000a tubes). Penetrating injuries due to external forces (e.g., stab wounds, gunshots) are less frequent. For the therapeutic

Paul M. Schneider; Georg Lurje; Peter Bauerfeind; Marc Schiesser

123

Optimizing the data combination rule for seamless phase?II/III clinical trials.  

PubMed

We consider seamless phase?II/III clinical trials that compare K treatments with a common control in phase?II then test the most promising treatment against control in phase?III. The final hypothesis test for the selected treatment can use data from both phases, subject to controlling the familywise type?I error rate. We show that the choice of method for conducting the final hypothesis test has a substantial impact on the power to demonstrate that an effective treatment is superior to control. To understand these differences in power, we derive decision rules maximizing power for particular configurations of treatment effects. A rule with such an optimal frequentist property is found as the solution to a multivariate Bayes decision problem. The optimal rules that we derive depend on the assumed configuration of treatment means. However, we are able to identify two decision rules with robust efficiency: a rule using a weighted average of the phase II and phase III data on the selected treatment and control, and a closed testing procedure using an inverse normal combination rule and a Dunnett test for intersection hypotheses. For the first of these rules, we find the optimal division of a given total sample size between phases II and III. We also assess the value of using phase?II data in the final analysis and find that for many plausible scenarios, between 50% and 70% of the phase?II numbers on the selected treatment and control would need to be added to the phase?III sample size in order to achieve the same increase in power. ©?2014 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd. PMID:25315892

Hampson, Lisa V; Jennison, Christopher

2015-01-15

124

Optimizing the data combination rule for seamless phase?II/III clinical trials  

PubMed Central

We consider seamless phase?II/III clinical trials that compare K treatments with a common control in phase?II then test the most promising treatment against control in phase?III. The final hypothesis test for the selected treatment can use data from both phases, subject to controlling the familywise type?I error rate. We show that the choice of method for conducting the final hypothesis test has a substantial impact on the power to demonstrate that an effective treatment is superior to control. To understand these differences in power, we derive decision rules maximizing power for particular configurations of treatment effects. A rule with such an optimal frequentist property is found as the solution to a multivariate Bayes decision problem. The optimal rules that we derive depend on the assumed configuration of treatment means. However, we are able to identify two decision rules with robust efficiency: a rule using a weighted average of the phase II and phase III data on the selected treatment and control, and a closed testing procedure using an inverse normal combination rule and a Dunnett test for intersection hypotheses. For the first of these rules, we find the optimal division of a given total sample size between phases II and III. We also assess the value of using phase?II data in the final analysis and find that for many plausible scenarios, between 50% and 70% of the phase?II numbers on the selected treatment and control would need to be added to the phase?III sample size in order to achieve the same increase in power. PMID:25315892

Hampson, Lisa V; Jennison, Christopher

2015-01-01

125

Esophageal Manifestations of Multisystem Diseases  

PubMed Central

The esophagus may be involved directly or indirectly by numerous disease conditions. On occasion, the esophageal process may be the key to the diagnosis. In some situations, the esophageal manifestation of a disease may be more immediately life-threatening than the primary process. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6 PMID:7310903

Mapp, Esmond

1980-01-01

126

Treatment options for esophageal strictures  

Microsoft Academic Search

Esophageal strictures are a problem commonly encountered in gastroenterological practice and can be caused by malignant or benign lesions. Dysphagia is the symptom experienced by all patients, regardless of whether their strictures are caused by malignant or benign lesions. The methods most frequently used for palliation of malignant esophageal strictures are stent placement (particularly in patients with an expected survival

Peter D Siersema

2008-01-01

127

21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.  

Code of Federal Regulations, 2011 CFR

...false Esophageal stethoscope with electrical conductors. 868.1920 Section...1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical conductors is a device...

2011-04-01

128

21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.  

Code of Federal Regulations, 2013 CFR

...false Esophageal stethoscope with electrical conductors. 868.1920 Section...1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical conductors is a device...

2013-04-01

129

21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.  

Code of Federal Regulations, 2012 CFR

...false Esophageal stethoscope with electrical conductors. 868.1920 Section...1920 Esophageal stethoscope with electrical conductors. (a) Identification. An esophageal stethoscope with electrical conductors is a device...

2012-04-01

130

[Esophageal toxicity of radiation therapy: clinical risk factors and management].  

PubMed

Acute radiation-induced esophagitis includes all clinical symptoms (odynophagia, dysphagia) occurring within 90 days after thoracic irradiation start. Its severity can be graded using RTOG and CTCAE scales. The clinical risk factors are: age, female gender, initial performance status, pre-therapeutic body mass index, pre-therapeutic dysphagia, tumoral and nodal stage, delivered dose, accelerated hyperfractionned radiotherapy, concomitant association of chemotherapy to radiotherapy and response to the treatment. The dosimetric parameters predictive of esophagitis are: mean dose, V(20Gy), V(30Gy), V(40Gy), V(45Gy) and V(50Gy). Amifostine is the only drug to have a proven radioprotective efficacy (evidence level C, ESMO recommendation grade III). The medical management of esophagitis associates a diet excluding irritant food, medication against gastroesophageal reflux, analgesic treatment according to the WHO scale and management of dehydration and denutrition by enteral feeding. PMID:22925486

Challand, T; Thureau, S; Dubray, B; Giraud, P

2012-09-01

131

Significance of tumor length as prognostic factor for esophageal cancer.  

PubMed

Our study indicated the relationship between tumor length and clinicopathologic characteristics as well as long-term survival in esophageal cancer. A total of 116 patients who underwent curative surgery for thoracic esophageal cancer with standard lymphadenectomy in 2 fields between 2000 and 2010 were included in the study. The medical records of these patients were retrospectively reviewed. The patients with tumor length 3 cm had a highly significant difference in the involvement of adventitia and lymph node stations. The patients with tumor length 3 cm had significantly lower rates of involvement of the adventitia and lymph node stations. Tumor length could have a significant impact on both the overall survival and disease-free survival of patients with resected esophageal carcinomas and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment. PMID:23971777

Zeybek, Arife; Erdo?an, Abdullah; Gülkesen, Kemal Hakan; Ergin, Makbule; Sarper, Alpay; Dertsiz, Levent; Demircan, Abid

2013-01-01

132

Significance of Tumor Length as Prognostic Factor for Esophageal Cancer  

PubMed Central

Our study indicated the relationship between tumor length and clinicopathologic characteristics as well as long-term survival in esophageal cancer. A total of 116 patients who underwent curative surgery for thoracic esophageal cancer with standard lymphadenectomy in 2 fields between 2000 and 2010 were included in the study. The medical records of these patients were retrospectively reviewed. The patients with tumor length ?3 cm had a highly significant difference in the involvement of adventitia and lymph node stations. The patients with tumor length ?3 cm had significantly lower rates of involvement of the adventitia and lymph node stations. Tumor length could have a significant impact on both the overall survival and disease-free survival of patients with resected esophageal carcinomas and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment. PMID:23971777

Zeybek, Arife; Erdo?an, Abdullah; Gülkesen, Kemal Hakan; Ergin, Makbule; Sarper, Alpay; Dertsiz, Levent; Demircan, Abid

2013-01-01

133

[Computerized analysis of esophageal manometry].  

PubMed

Computerized analysis of esophageal manometry should consider the following objectives: a) objectivation of data acquisition; b) precision in calculating the various parameters; c) speed of analysis; d) an easy-to-read and promptly understandable graphic display of the manometric data; e) computation of new parameters capable of defining normal and pathologic function. It is with these objectives in mind that we launched our research project. Five normal subjects and 10 patients, of whom 5 presented esophageal achalasia and 5 gastroesophageal reflux disease, underwent computerized esophageal manometry and were evaluated on the basis of both traditional and innovative parameters, of our own inception. Among the various indexes tested, the "Esophageal transport" parameter, calculated as the ratio of momentum (dp*dT) over speed of propagation of the esophageal contractions, gave rise to particular interest. In our opinion, this parameter can be used as an index of the dynamic function of the organ. PMID:2067691

Spigno, L; Pandolfo, N; Guiddo, G; Calci, G; Mattioli, G; De Salvo, L

1991-04-15

134

Lymph Node Metastases in Esophageal Carcinoma: An Endoscopist's View.  

PubMed

One of the most important prognostic factors in esophageal carcinoma is lymph node metastasis, and in particular, the number of affected lymph nodes, which influences long-term outcomes. The esophageal lymphatic system is connected longitudinally and transversally; thus, the pattern of lymph node metastases is very complex. Early esophageal cancer frequently exhibits skipped metastasis, and minimal surgery using sentinel node navigation cannot be performed. In Korea, most esophageal cancer cases are squamous cell carcinoma (SCC), although the incidence of adenocarcinoma has started to increase recently. Most previous reports have failed to differentiate between SCC and adenocarcinoma, despite the fact that the Union for International Cancer Control (7th edition) and American Joint Committee on Cancer staging systems both consider these separately because they differ in cause, biology, lymph node metastasis, and outcome. Endoscopic tumor resection is an effective and safe treatment for lesions with no associated lymph node metastasis. Esophageal mucosal cancer confined to the lamina propria is an absolute indication for endoscopic resection, and a lesion that has invaded the muscularis mucosae can be cured by local resection if invasion to the lymphatic system has not occurred. PMID:25505718

Cho, Jin Woong; Choi, Suck Chei; Jang, Jae Young; Shin, Sung Kwan; Choi, Kee Don; Lee, Jun Haeng; Kim, Sang Gyun; Sung, Jae Kyu; Jeon, Seong Woo; Choi, Il Ju; Kim, Gwang Ha; Jee, Sam Ryong; Lee, Wan Sik; Jung, Hwoon-Yong

2014-11-01

135

DDEC: Dragon database of genes implicated in esophageal cancer  

PubMed Central

Background Esophageal cancer ranks eighth in order of cancer occurrence. Its lethality primarily stems from inability to detect the disease during the early organ-confined stage and the lack of effective therapies for advanced-stage disease. Moreover, the understanding of molecular processes involved in esophageal cancer is not complete, hampering the development of efficient diagnostics and therapy. Efforts made by the scientific community to improve the survival rate of esophageal cancer have resulted in a wealth of scattered information that is difficult to find and not easily amendable to data-mining. To reduce this gap and to complement available cancer related bioinformatic resources, we have developed a comprehensive database (Dragon Database of Genes Implicated in Esophageal Cancer) with esophageal cancer related information, as an integrated knowledge database aimed at representing a gateway to esophageal cancer related data. Description Manually curated 529 genes differentially expressed in EC are contained in the database. We extracted and analyzed the promoter regions of these genes and complemented gene-related information with transcription factors that potentially control them. We further, precompiled text-mined and data-mined reports about each of these genes to allow for easy exploration of information about associations of EC-implicated genes with other human genes and proteins, metabolites and enzymes, toxins, chemicals with pharmacological effects, disease concepts and human anatomy. The resulting database, DDEC, has a useful feature to display potential associations that are rarely reported and thus difficult to identify. Moreover, DDEC enables inspection of potentially new 'association hypotheses' generated based on the precompiled reports. Conclusion We hope that this resource will serve as a useful complement to the existing public resources and as a good starting point for researchers and physicians interested in EC genetics. DDEC is freely accessible to academic and non-profit users at http://apps.sanbi.ac.za/ddec/. DDEC will be updated twice a year. PMID:19580656

2009-01-01

136

Erlotinib Hydrochloride in Treating Patients With Previously Treated Non-Small Cell Lung Cancer, Head and Neck Cancer, or Esophageal Cancer and Precancerous Lesions of the Lung  

ClinicalTrials.gov

High-grade Salivary Gland Mucoepidermoid Carcinoma; Low-grade Salivary Gland Mucoepidermoid Carcinoma; Occult Non-small Cell Lung Cancer; Salivary Gland Acinic Cell Tumor; Salivary Gland Adenocarcinoma; Salivary Gland Adenoid Cystic Carcinoma; Salivary Gland Anaplastic Carcinoma; Salivary Gland Malignant Mixed Cell Type Tumor; Salivary Gland Poorly Differentiated Carcinoma; Salivary Gland Squamous Cell Carcinoma; Squamous Lung Dysplasia; Stage 0 Esophageal Cancer; Stage 0 Non-small Cell Lung Cancer; Stage I Adenoid Cystic Carcinoma of the Oral Cavity; Stage I Basal Cell Carcinoma of the Lip; Stage I Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage I Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage I Lymphoepithelioma of the Nasopharynx; Stage I Lymphoepithelioma of the Oropharynx; Stage I Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage I Mucoepidermoid Carcinoma of the Oral Cavity; Stage I Non-small Cell Lung Cancer; Stage I Salivary Gland Cancer; Stage I Squamous Cell Carcinoma of the Hypopharynx; Stage I Squamous Cell Carcinoma of the Larynx; Stage I Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage I Squamous Cell Carcinoma of the Nasopharynx; Stage I Squamous Cell Carcinoma of the Oropharynx; Stage I Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage I Verrucous Carcinoma of the Larynx; Stage I Verrucous Carcinoma of the Oral Cavity; Stage IA Esophageal Cancer; Stage IB Esophageal Cancer; Stage II Adenoid Cystic Carcinoma of the Oral Cavity; Stage II Basal Cell Carcinoma of the Lip; Stage II Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage II Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage II Lymphoepithelioma of the Nasopharynx; Stage II Lymphoepithelioma of the Oropharynx; Stage II Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage II Mucoepidermoid Carcinoma of the Oral Cavity; Stage II Non-small Cell Lung Cancer; Stage II Salivary Gland Cancer; Stage II Squamous Cell Carcinoma of the Hypopharynx; Stage II Squamous Cell Carcinoma of the Larynx; Stage II Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage II Squamous Cell Carcinoma of the Nasopharynx; Stage II Squamous Cell Carcinoma of the Oropharynx; Stage II Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage II Verrucous Carcinoma of the Larynx; Stage II Verrucous Carcinoma of the Oral Cavity; Stage IIA Esophageal Cancer; Stage IIB Esophageal Cancer; Stage III Adenoid Cystic Carcinoma of the Oral Cavity; Stage III Basal Cell Carcinoma of the Lip; Stage III Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage III Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage III Lymphoepithelioma of the Nasopharynx; Stage III Lymphoepithelioma of the Oropharynx; Stage III Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage III Mucoepidermoid Carcinoma of the Oral Cavity; Stage III Salivary Gland Cancer; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous Carcinoma of the Oral Cavity; Stage IIIA Esophageal Cancer; Stage IIIA Non-small Cell Lung Cancer; Stage IIIB Esophageal Cancer; Stage IIIB Non-small Cell Lung Cancer; Stage IIIC Esophageal Cancer; Stage IV Adenoid Cystic Carcinoma of the Oral Cavity; Stage IV Basal Cell Carcinoma of the Lip; Stage IV Esophageal Cancer; Stage IV Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage IV Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage IV Lymphoepithelioma of the Nasopharynx; Stage IV Lymphoepithelioma of the Oropharynx; Stage IV Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage IV Mucoepidermoid Carc

2014-09-12

137

Microwave analysis of mortar prepared with type I/II, III and V cement and subjected to cyclical chloride exposure  

NASA Astrophysics Data System (ADS)

The presence of a sufficient concentration of chloride ions at the steel/concrete interface can lead to the initiation of corrosion in reinforced concrete structures. To this end, a set of near-field microwave nondestructive testing experiments were conducted using three mortar specimens made with three different cements: ASTM Type I/II, III and V. These specimens were cyclically exposed to a chloride solution and their daily microwave reflection properties were measured. These measurements indicate that the technique may be able to differentiate between the specimens.

Case, J. T.; Zoughi, R.; Donnell, K.; Hughes, D.; Kurtis, K. E.

2002-05-01

138

Esophageal tissue engineering: a new approach for esophageal replacement.  

PubMed

A number of congenital and acquired disorders require esophageal tissue replacement. Various surgical techniques, such as gastric and colonic interposition, are standards of treatment, but frequently complicated by stenosis and other problems. Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function. We review the literature of esophageal tissue engineering, discuss its implications, compare the methodologies that have been employed and suggest possible directions for the future. Medline, Embase, the Cochrane Library, National Research Register and ClinicalTrials.gov databases were searched with the following search terms: stem cell and esophagus, esophageal replacement, esophageal tissue engineering, esophageal substitution. Reference lists of papers identified were also examined and experts in this field contacted for further information. All full-text articles in English of all potentially relevant abstracts were reviewed. Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation. When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality. Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration, whilst omental wrapping to induce vascularization of the construct has an uncertain benefit. Decellularized matrices have been recently suggested as the optimal choice for scaffolds, but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution. Results in animal models that have used seeded scaffolds strongly suggest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a prerequisite for complete esophageal replacement. Novel approaches need to be designed to allow for peristalsis and vascularization in the engineered esophagus. Although esophageal tissue engineering potentially offers a real alternative to conventional treatments for severe esophageal disease, important barriers remain that need to be addressed. PMID:23322987

Totonelli, Giorgia; Maghsoudlou, Panagiotis; Fishman, Jonathan M; Orlando, Giuseppe; Ansari, Tahera; Sibbons, Paul; Birchall, Martin A; Pierro, Agostino; Eaton, Simon; De Coppi, Paolo

2012-12-21

139

Comparison of esophageal capsule endoscopy and esophagogastroduodenoscopy for diagnosis of esophageal varices  

PubMed Central

AIM: To investigate the utility of esophageal capsule endoscopy in the diagnosis and grading of esophageal varices. METHODS: Cirrhotic patients who were undergoing esophagogastroduodenoscopy (EGD) for variceal screening or surveillance underwent capsule endoscopy. Two separate blinded investigators read each capsule endoscopy for the following results: variceal grade, need for treatment with variceal banding or prophylaxis with beta-blocker therapy, degree of portal hypertensive gastropathy, and gastric varices. RESULTS: Fifty patients underwent both capsule and EGD. Forty-eight patients had both procedures on the same day, and 2 patients had capsule endoscopy within 72 h of EGD. The accuracy of capsule endoscopy to decide on the need for prophylaxis was 74%, with sensitivity of 63% and specificity of 82%. Inter-rater agreement was moderate (kappa = 0.56). Agreement between EGD and capsule endoscopy on grade of varices was 0.53 (moderate). Inter-rater reliability was good (kappa = 0.77). In diagnosis of portal hypertensive gastropathy, accuracy was 57%, with sensitivity of 96% and specificity of 17%. Two patients had gastric varices seen on EGD, one of which was seen on capsule endoscopy. There were no complications from capsule endoscopy. CONCLUSION: We conclude that capsule endoscopy has a limited role in deciding which patients would benefit from EGD with banding or beta-blocker therapy. More data is needed to assess accuracy for staging esophageal varices, PHG, and the detection of gastric varices. PMID:18680226

Frenette, Catherine T; Kuldau, John G; Hillebrand, Donald J; Lane, Jill; Pockros, Paul J

2008-01-01

140

Esophageal Cancer in Esophageal Diverticula Associated with Achalasia  

PubMed Central

The simultaneous occurrence of achalasia and esophageal diverticula is rare. Here, we report the case of a 68-year-old man with multiple esophageal diverticula associated with achalasia who was later diagnosed with early esophageal cancer. He initially presented with dysphagia and dyspepsia, and injection of botulinum toxin to the lower esophageal sphincter relieved his symptoms. Five years later, however, the patient presented with worsening of symptoms, and esophagogastroduodenoscopy (EGD) was performed. The endoscopic findings showed multifocal lugol-voiding lesions identified as moderate dysplasia. We decided to use photodynamic therapy to treat the multifocal dysplastic lesions. At follow-up EGD 2 months after photodynamic therapy, more lugol-voiding lesions representing a squamous cell carcinoma in situ were found. The patient ultimately underwent surgery for the treatment of recurrent esophageal multifocal neoplasia. After a follow-up period of 3 years, the patient showed a good outcome without symptoms. To manage premalignant lesions such as achalasia with esophageal diverticula, clinicians should be cautious, but have an aggressive approach regarding endoscopic surveillance.

Choi, Ah Ran; Chon, Nu Ri; Youn, Young Hoon; Paik, Hyo Chae; Kim, Yon Hee

2015-01-01

141

Esophageal cancer in esophageal diverticula associated with achalasia.  

PubMed

The simultaneous occurrence of achalasia and esophageal diverticula is rare. Here, we report the case of a 68-year-old man with multiple esophageal diverticula associated with achalasia who was later diagnosed with early esophageal cancer. He initially presented with dysphagia and dyspepsia, and injection of botulinum toxin to the lower esophageal sphincter relieved his symptoms. Five years later, however, the patient presented with worsening of symptoms, and esophagogastroduodenoscopy (EGD) was performed. The endoscopic findings showed multifocal lugol-voiding lesions identified as moderate dysplasia. We decided to use photodynamic therapy to treat the multifocal dysplastic lesions. At follow-up EGD 2 months after photodynamic therapy, more lugol-voiding lesions representing a squamous cell carcinoma in situ were found. The patient ultimately underwent surgery for the treatment of recurrent esophageal multifocal neoplasia. After a follow-up period of 3 years, the patient showed a good outcome without symptoms. To manage premalignant lesions such as achalasia with esophageal diverticula, clinicians should be cautious, but have an aggressive approach regarding endoscopic surveillance. PMID:25674530

Choi, Ah Ran; Chon, Nu Ri; Youn, Young Hoon; Paik, Hyo Chae; Kim, Yon Hee; Park, Hyojin

2015-01-01

142

Hyperfractionated Concomitant Boost Proton Beam Therapy for Esophageal Carcinoma  

SciTech Connect

Purpose: To evaluate the efficacy and safety of hyperfractionated concomitant boost proton beam therapy (PBT) for patients with esophageal cancer. Methods and Materials: The study participants were 19 patients with esophageal cancer who were treated with hyperfractionated photon therapy and PBT between 1990 and 2007. The median total dose was 78 GyE (range, 70-83 GyE) over a median treatment period of 48 days (range, 38-53 days). Ten of the 19 patients were at clinical T Stage 3 or 4. Results: There were no cases in which treatment interruption was required because of radiation-induced esophagitis or hematologic toxicity. The overall 1- and 5-year actuarial survival rates for all 19 patients were 79.0% and 42.8%, respectively, and the median survival time was 31.5 months (95% limits: 16.7- 46.3 months). Of the 19 patients, 17 (89%) showed a complete response within 4 months after completing treatment and 2 (11%) showed a partial response, giving a response rate of 100% (19/19). The 1- and 5-year local control rates for all 19 patients were 93.8% and 84.4 %, respectively. Only 1 patient had late esophageal toxicity of Grade 3 at 6 months after hyperfractionated PBT. There were no other nonhematologic toxicities, including no cases of radiation pneumonia or cardiac failure of Grade 3 or higher. Conclusions: The results suggest that hyperfractionated PBT is safe and effective for patients with esophageal cancer. Further studies are needed to establish the appropriate role and treatment schedule for use of PBT for esophageal cancer.

Mizumoto, Masashi [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Sugahara, Shinji [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Tokyo Medical University Ibaraki Medical Center, Ibaraki (Japan); Okumura, Toshiyuki; Hashimoto, Takayuki; Oshiro, Yoshiko; Fukumitsu, Nobuyoshi [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Nakahara, Akira [Department of Gastroenterological Medicine, University of Tsukuba, Tsukuba, Ibaraki (Japan); Terashima, Hideo [Department of Surgery, University of Tsukuba, Tsukuba, Ibaraki (Japan); Tsuboi, Koji [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan); Sakurai, Hideyuki, E-mail: hsakurai@pmrc.tsukuba.ac.jp [Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki (Japan)

2011-11-15

143

Drugs Approved for Esophageal Cancer  

Cancer.gov

This page lists cancer drugs approved by the Food and Drug Administration (FDA) for esophageal cancer. The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries.

144

General Information about Esophageal Cancer  

MedlinePLUS

... layers of tissue , including mucous membrane , muscle, and connective tissue . Esophageal cancer starts at the inside lining of ... and spread into the muscle layer or the connective tissue layer of the esophagus wall. The cancer cells ...

145

Esophageal Cancer - Featured Clinical Trials  

Cancer.gov

Esophageal Cancer - Featured Clinical Trials The following list shows Featured Clinical Trials for a specific type of cancer. You may also want to view: Multiple Cancer Types - Featured Clinical Trials Supportive Care - Featured Clinical Trials

146

Environmental Causes of Esophageal Cancer  

PubMed Central

Synopsis This articles reviews the environmental risk factors and predisposing conditions for the two main histological types of esophageal cancer, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EA). Tobacco smoking, excessive alcohol consumption, drinking maté, low intake of fresh fruits and vegetables, achalasia, and low socioeconomic status increase the risk of ESCC. Results of investigations on several other potential risk factors, including opium consumption, intake of hot drinks, eating pickled vegetables, poor oral health, and exposure to human papillomavirus, polycyclic aromatic hydrocarbons, N-nitroso compounds, acetaldehyde, and fumonisins are also discussed. Gastroesophageal reflux, obesity, tobacco smoking, hiatal hernia, achalasia, and probably absence of H. pylori in the stomach increase the risk of EA. Results of studies investigating other factors, including low intake of fresh fruits and vegetables, consumption of carbonated soft drink, use of H2 blockers, non-steroidal anti-inflammatory drugs, and drugs that relax the lower esophageal sphincter are also discussed. PMID:19327566

Kamangar, Farin; Chow, Wong-Ho; Abnet, Christian; Dawsey, Sanford

2009-01-01

147

Replacement surgery for esophageal atresia.  

PubMed

Esophageal replacement surgery is the treatment of choice in children with esophageal atresia (EA) when a long defect does not allow restoration of esophageal continuity, or when primary repair has failed. The stomach, colon, and small intestine have been used successfully to create conduits, but there is still no consensus among pediatric surgeons regarding the optimal method for substituting the native esophagus. Current evidence on short- and long-term outcomes of esophageal replacement originates from small-size, retrospective reports and well-designed comparative studies are lacking. Moreover, there is significant heterogeneity in the way outcomes are reported, which makes data pooling and comparison very challenging. In this review, we focus on the most recent evidence on outcomes of the most popular replacement techniques (colonic interposition, gastric transposition, gastric tube reconstruction, and jejunal interposition) used in pediatric patients with EA. PMID:23720209

Loukogeorgakis, Stavros P; Pierro, Agostino

2013-06-01

148

Upper esophageal and pharyngeal cancers.  

PubMed

The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on laryngopharyngeal reflux as a risk factor for laryngeal cancer; the role of pepsin in laryngopharyngeal neoplasia; natural fruit and vegetable compounds for the prevention and treatment of pharyngeal and esophageal cancers; and evaluation of cranberry constituents as inhibitors of esophageal adenocarcinoma utilizing in vitro assay and in vivo models. PMID:25266014

Bock, Jonathan M; Howell, Amy B; Johnston, Nikki; Kresty, Laura A; Lew, Daniel

2014-09-01

149

Drug-induced esophageal strictures.  

PubMed Central

A retrospective study of 55 patients with a benign esophageal stricture showed that in 11 patients (20%) the cause was a drug-induced lesion due to potassium chloride (3), tetracyclines (3), aspirin (2), vitamin C (1), phenytoin (1), and quinidine (1). Five of the 11 patients would have been diagnosed as having a reflux etiology of their stricture if 24-hour esophageal pH monitoring was not performed. Six patients responded to dilatation and five patients required resection or bypass. A prospective study of 18 asymptomatic volunteers showed a high incidence of esophageal lodgment of a radiolabeled medicinal capsule, with subsequent dissolution and release of the isotope. This occurred most frequently in elderly subjects and was reduced by increasing the volume of water chaser. The sites of lodgment correspond to the location of the observed strictures in the patient population. An in vitro study showed that, when the causative drugs were mixed with saliva, dissolution occurred within 60 minutes and was associated with significant changes in pH. These investigations show that drug-induced esophageal strictures are more common than previously appreciated, and can be confused with a reflux etiology. Diagnosis is suggested by a history of drug ingestion, location of the stricture, and a normal esophageal acid exposure on 24-hour pH monitoring. The severity of the esophageal injury is variable and requires dilatation to resection for therapy. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 5. Fig. 6. PMID:3606243

Bonavina, L; DeMeester, T R; McChesney, L; Schwizer, W; Albertucci, M; Bailey, R T

1987-01-01

150

Black esophagus: Acute esophageal necrosis syndrome  

PubMed Central

Acute esophageal necrosis (AEN), commonly referred to as “black esophagus”, is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic compromise and low-flow states, corrosive injury from gastric contents in the setting of esophago-gastroparesis and gastric outlet obstruction, and decreased function of mucosal barrier systems and reparative mechanisms present in malnourished and debilitated physical states. AEN may arise in the setting of multiorgan dysfunction, hypoperfusion, vasculopathy, sepsis, diabetic ketoacidosis, alcohol intoxication, gastric volvulus, traumatic transection of the thoracic aorta, thromboembolic phenomena, and malignancy. Clinical presentation is remarkable for upper gastrointestinal bleeding. Notable symptoms may include epigastric/abdominal pain, vomiting, dysphagia, fever, nausea, and syncope. Associated laboratory findings may reflect anemia and leukocytosis. The hallmark of this syndrome is the development of diffuse circumferential black mucosal discoloration in the distal esophagus that may extend proximally to involve variable length of the organ. Classic “black esophagus” abruptly stops at the gastroesophageal junction. Biopsy is recommended but not required for the diagnosis. Histologically, necrotic debris, absence of viable squamous epithelium, and necrosis of esophageal mucosa, with possible involvement of submucosa and muscularis propria, are present. Classification of the disease spectrum is best described by a staging system. Treatment is directed at correcting coexisting clinical conditions, restoring hemodynamic stability, nil-per-os restriction, supportive red blood cell transfusion, and intravenous acid suppression with proton pump inhibitors. Complications include perforation with mediastinal infection/abscess, esophageal stricture and stenosis, superinfection, and death. A high mortality of 32% seen in the setting of AEN syndrome is usually related to the underlying medical co-morbidities and diseases. PMID:20614476

Gurvits, Grigoriy E

2010-01-01

151

Hyperthermochemoradiotherapy and esophageal carcinoma  

SciTech Connect

Cancer of the esophagus still poses considerable treatment problems, with a poor 5-year survival rate after surgery, an even worse outlook after radiation and surgery, and a not very satisfactory response to chemotherapy. After several years of continued research, in 1983 we developed a Radio Frequency System with endotract electrode and thermosensors for administering hyperthermochemoradiotherapy to patients with carcinoma of the esophagus. Results in 129 patients are discussed. Immediate improvement of subjective complaints and decrease or elimination of the cancer lesion are so distinct that this treatment, by means of an endotract antenna, shows promise as a modality for esophageal lesions and may find application in diseases such as colorectal cancer or carcinoma of the uterine cervix.

Sugimachi, K.; Inokuchi, K.

1986-01-01

152

Spontaneous esophageal mucosal dissection in a patient with upper digestive bleeding and esophageal varices.  

PubMed

We present a case of mucosal esophageal dissection in a 44-year-old patient with alcoholic cirrhosis admitted for upper digestive bleeding. The endoscopic aspect was of chronic mucosal dissection in the esophagus and 3rd degree esophageal varices with red signs. To our knowledge, it is the only case with spontaneous esophageal mucosal dissection and portal hypertension with esophageal varices. PMID:21776303

Negreanu, L; Tribus, L C; Purcarea, M; Fierbinteanu Braticevici, C

2011-05-15

153

Spontaneous esophageal mucosal dissection in a patient with upper digestive bleeding and esophageal varices  

PubMed Central

We present a case of mucosal esophageal dissection in a 44–year–old patient with alcoholic cirrhosis admitted for upper digestive bleeding. The endoscopic aspect was of chronic mucosal dissection in the esophagus and 3rd degree esophageal varices with red signs. To our knowledge, it is the only case with spontaneous esophageal mucosal dissection and portal hypertension with esophageal varices. PMID:21776303

Tribus, LC; Purcarea, M; Fierbinteanu Braticevici, C

2011-01-01

154

Recursive Partitioning Analysis for New Classification of Patients With Esophageal Cancer Treated by Chemoradiotherapy  

SciTech Connect

Background: The 7th edition of the American Joint Committee on Cancer staging system does not include lymph node size in the guidelines for staging patients with esophageal cancer. The objectives of this study were to determine the prognostic impact of the maximum metastatic lymph node diameter (ND) on survival and to develop and validate a new staging system for patients with esophageal squamous cell cancer who were treated with definitive chemoradiotherapy (CRT). Methods: Information on 402 patients with esophageal cancer undergoing CRT at two institutions was reviewed. Univariate and multivariate analyses of data from one institution were used to assess the impact of clinical factors on survival, and recursive partitioning analysis was performed to develop the new staging classification. To assess its clinical utility, the new classification was validated using data from the second institution. Results: By multivariate analysis, gender, T, N, and ND stages were independently and significantly associated with survival (p < 0.05). The resulting new staging classification was based on the T and ND. The four new stages led to good separation of survival curves in both the developmental and validation datasets (p < 0.05). Conclusions: Our results showed that lymph node size is a strong independent prognostic factor and that the new staging system, which incorporated lymph node size, provided good prognostic power, and discriminated effectively for patients with esophageal cancer undergoing CRT.

Nomura, Motoo, E-mail: excell@hkg.odn.ne.jp [Department of Radiology, Kansai Medical University, Hirakata (Japan) [Department of Radiology, Kansai Medical University, Hirakata (Japan); Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya (Japan); Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya (Japan); Shitara, Kohei [Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya (Japan)] [Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya (Japan); Kodaira, Takeshi [Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya (Japan)] [Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya (Japan); Kondoh, Chihiro; Takahari, Daisuke; Ura, Takashi [Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya (Japan)] [Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya (Japan); Kojima, Hiroyuki; Kamata, Minoru [Department of Radiology, Kansai Medical University, Hirakata (Japan)] [Department of Radiology, Kansai Medical University, Hirakata (Japan); Muro, Kei [Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya (Japan)] [Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya (Japan); Sawada, Satoshi [Department of Radiology, Kansai Medical University, Hirakata (Japan)] [Department of Radiology, Kansai Medical University, Hirakata (Japan)

2012-11-01

155

21 CFR 878.3610 - Esophageal prosthesis.  

Code of Federal Regulations, 2011 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...

2011-04-01

156

21 CFR 878.3610 - Esophageal prosthesis.  

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...

2014-04-01

157

21 CFR 878.3610 - Esophageal prosthesis.  

Code of Federal Regulations, 2012 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...

2012-04-01

158

21 CFR 878.3610 - Esophageal prosthesis.  

Code of Federal Regulations, 2010 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...

2010-04-01

159

21 CFR 878.3610 - Esophageal prosthesis.  

Code of Federal Regulations, 2013 CFR

... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3610 Esophageal prosthesis. (a) Identification. An esophageal...

2013-04-01

160

Esophageal rupture complicated by acute pericarditis.  

PubMed

Esophageal perforation is a serious condition with a high mortality rate. Delayed detection of esophageal perforation may result in devastating complications such as mediastinitis and pericarditis. Esophageal perforation is rarely due to aspiration of foreign bodies. Here we report the case of a 59-year-old male patient with complicated esophageal perforation due to ingestion of a chicken bone, whose first signs are considered to be acute non-specific pericarditis. PMID:25490302

Duman, Hakan; Bak?rc?, Eftal Murat; Karada?, Zakir; U?urlu, Yavuz

2014-10-01

161

Proton Beam Therapy of Stage II and III Non-Small-Cell Lung Cancer  

SciTech Connect

Purpose: The present retrospective study assessed the role of proton beam therapy (PBT) in the treatment of patients with Stage II or III non-small-cell lung cancer who were inoperable or ineligible for chemotherapy because of co-existing disease or refusal. Patients and Methods: Between November 2001 and July 2008, PBT was given to 35 patients (5 patients with Stage II, 12 with Stage IIIA, and 18 with Stage IIIB) whose median age was 70.3 years (range, 47.4-85.4). The median proton dose given was 78.3 Gy (range, 67.1-91.3) (relative biologic effectiveness). Results: Local progression-free survival for Stage II-III patients was 93.3% at 1 year and 65.9% at 2 years during a median observation period of 16.9 months. Four patients (11.4%) developed local recurrence, 13 (37.1%) developed regional recurrence, and 7 (20.0%) developed distant metastases. The progression-free survival rate for Stage II-III patients was 59.6% at 1 year and 29.2% at 2 years. The overall survival rate of Stage II-III patients was 81.8% at 1 year and 58.9% at 2 years. Grade 3 or greater toxicity was not observed. A total of 15 patients (42.9%) developed Grade 1 and 6 (17.1%) Grade 2 toxicity. Conclusion: PBT for Stage II-III non-small-cell lung cancer without chemotherapy resulted in good local control and low toxicity. PBT has a definite role in the treatment of patients with Stage II-III non-small-cell lung cancer who are unsuitable for surgery or chemotherapy.

Nakayama, Hidetsugu, E-mail: hnakayam@tokyo-med.ac.jp [Proton Medical Research Center, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, Tokyo Medical University, Shinjuku, Tokyo (Japan); Satoh, Hiroaki [Department of Respiratory Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki (Japan); Sugahara, Shinji [Proton Medical Research Center, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, Tokyo Medical University, Shinjuku, Tokyo (Japan); Kurishima, Koichi [Department of Respiratory Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki (Japan); Tsuboi, Koji; Sakurai, Hideyuki [Proton Medical Research Center, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki (Japan); Ishikawa, Shigemi [Department of Thoracic Surgery, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki (Japan); Tokuuye, Koichi [Proton Medical Research Center, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki (Japan); Department of Radiation Oncology, Tokyo Medical University, Shinjuku, Tokyo (Japan)

2011-11-15

162

Esophagitis in Children with Celiac Disease  

PubMed Central

Objectives. To our knowledge, the occurrence of esophagitis in children with celiac disease (CD) has never been evaluated. The aim of this study is to determine the prevalence of esophagitis in children with CD. Patients and Methods. Between 2003 and 2007, children with biopsy confirmed CD were retrospectively identified. Biopsy reports were reviewed for esophageal inflammation. Biopsy reports of 2218 endoscopies performed during the same period were also evaluated for inflammation. Results. Forty-nine children diagnosed with CD (47% boys). Nineteen of 49 (39%) patients with CD had esophagitis (95% CI 0.23–0.5). Thirty percent of boys and 46% of girls with CD had esophagitis (95% CI 0.12–0.40). Overall, 45% of patients who underwent upper endoscopy had esophagitis. The prevalence of esophagitis in CD (39%) compared to the prevalence of esophagitis (45%) in our practice was not significantly different, P = 0.2526. Conclusion. There was no difference in the prevalence of esophagitis between children diagnosed with CD at the time of their diagnostic EGD and the prevalence of esophagitis in children without CD. A prospective study to determine whether the esophagitis should be treated with acid suppression or whether the esophagitis heals with the gluten-free diet is warranted. PMID:21991513

Sayej, Wael N.; AlKhouri, Razan; Baker, Robert D.; Patel, Raza; Baker, Susan S.

2011-01-01

163

The Pathophysiology of Eosinophilic Esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is an emerging disease characterized by esophageal eosinophilia (>15eos/hpf), lack of responsiveness to acid-suppressive medication and is managed by allergen elimination and anti-allergy therapy. Although the pathophysiology of EoE is currently unsubstantiated, evidence implicates food and aeroallergen hypersensitivity in genetically predisposed individuals as contributory factors. Genome-wide expression analyses have isolated a remarkably conserved gene-expression profile irrespective of age and gender, suggesting a genetic contribution. EoE has characteristics of mainly TH2 type immune responses but also some TH1 cytokines, which appear to strongly contribute to tissue fibrosis, with esophageal epithelial cells providing a hospitable environment for this inflammatory process. Eosinophil-degranulation products appear to play a central role in tissue remodeling in EoE. This remodeling and dysregulation predisposes to fibrosis. Mast-cell-derived molecules such as histamine may have an effect on enteric nerves and may also act in concert with transforming growth factor-? to interfere with esophageal musculature. Additionally, the esophageal epithelium may facilitate the inflammatory process under pathogenic contexts such as in EoE. This article aims to discuss the contributory factors in the pathophysiology of EoE. PMID:24910846

Raheem, Mayumi; Leach, Steven T.; Day, Andrew S.; Lemberg, Daniel A.

2014-01-01

164

ESOPHAGEAL DYSMOTILITY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS. A STUDY USING PROLONGED ESOPHAGEAL MANOMETRY  

PubMed Central

Background The pathophysiology of dysphagia in patients with eosinophilic esophagitis (EoE) is unknown, but may be related to abnormal esophageal motor function. Symptoms rarely occur during stationary esophageal manometry so it has been difficult to establish an association between symptoms and motor events. Aim To evaluate esophageal motor function in children with EoE with the use of stationary manometry and ambulatory prolonged esophageal manometry and pH-metry (PEMP) Methods PEMP was performed in children with EoE, compared with controls and children with GERD. Effective peristalsis was considered when the esophageal contractions had a normal amplitude and propagation. Results expressed as mean ± S.E. Results Seventeen patients with EoE, 13 with GERD and 11 controls were studied. Values are expressed as mean ± se. Stationary manometry identified abnormal peristalsis in 41% of children with EoE. During PEMP, children with EoE had an increased number of isolated (16.7 ± 3.8 vs 9.5 ± 1.6 vs 6.5 ± 1.1 ; p< 0.03) and high amplitude contractions (4.1 ± 1.2 vs 1.8 ±0.8 vs 0.1 ± 0.1; p< 0.03), and more % ineffective peristalsis both during fasting (70.5% ± 2.5 vs 57.8% ± 3.0 vs 53.8% ± 1.9; p <0.05) and during meals (68.4 ± 3.4 vs 55.3 ± 2.8 vs 48.1 ± 2.8; p < 0.05) when compared with children with GERD and controls. Thirteen patients with EoE experienced 21 episodes of dysphagia and all correlated with simultaneous abnormal motor function. Conclusions PEMP allowed the detection of ineffective peristalsis in children with EoE. Symptoms observed in children with EoE may be related to esophageal motor dysfunction. PMID:19755968

Nurko, Samuel; Rosen, Rachel; Furuta, Glenn T.

2010-01-01

165

Esophageal tissue engineering: A new approach for esophageal replacement  

PubMed Central

A number of congenital and acquired disorders require esophageal tissue replacement. Various surgical techniques, such as gastric and colonic interposition, are standards of treatment, but frequently complicated by stenosis and other problems. Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function. We review the literature of esophageal tissue engineering, discuss its implications, compare the methodologies that have been employed and suggest possible directions for the future. Medline, Embase, the Cochrane Library, National Research Register and ClinicalTrials.gov databases were searched with the following search terms: stem cell and esophagus, esophageal replacement, esophageal tissue engineering, esophageal substitution. Reference lists of papers identified were also examined and experts in this field contacted for further information. All full-text articles in English of all potentially relevant abstracts were reviewed. Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation. When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality. Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration, whilst omental wrapping to induce vascularization of the construct has an uncertain benefit. Decellularized matrices have been recently suggested as the optimal choice for scaffolds, but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution. Results in animal models that have used seeded scaffolds strongly sug- gest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a prerequisite for complete esophageal replacement. Novel approaches need to be designed to allow for peristalsis and vascularization in the engineered esophagus. Although esophageal tissue engineering potentially offers a real alternative to conventional treatments for severe esophageal disease, important barriers remain that need to be addressed. PMID:23322987

Totonelli, Giorgia; Maghsoudlou, Panagiotis; Fishman, Jonathan M; Orlando, Giuseppe; Ansari, Tahera; Sibbons, Paul; Birchall, Martin A; Pierro, Agostino; Eaton, Simon; De Coppi, Paolo

2012-01-01

166

Sloughing Esophagitis: A Not So Common Entity  

PubMed Central

BACKGROUND: Sloughing esophagitis, also known as esophagitis dissecans superficialis, is a very rare and underdiagnosed entity with unknown incidence rate. It can be associated with bullous dermatoses and medications such as central nervous system depressants and those causing esophageal injury. CASE REPORT: A 55-years-old woman was recovering from renal failure due to rhabdomyolysis when she developed dysphagia and odynophagia. Esophagogastroduodenoscopy with biopsy was performed for suspected bullous pemphigus and confirmed sloughing esophagitis. She improved with intravenous steroids. CONCLUSIONS: Sloughing Esophagitis should enter our differential diagnosis more frequently. It is mostly a benign, self-limiting process but when associated with bullous dermatoses will require steroid treatment. PMID:25598761

Akhondi, Hossein

2014-01-01

167

Tissue remodeling in eosinophilic esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is a recently recognized, immune-mediated disease characterized clinically by symptoms of esophageal dysfunction and histologically by eosinophil-predominant inflammation. The chronic esophageal eosinophilia of EoE is associated with tissue remodeling that includes epithelial hyperplasia, subepithelial fibrosis, and hypertrophy of esophageal smooth muscle. This remodeling causes the esophageal rings and strictures that frequently complicate EoE and underlies the mucosal fragility that predisposes to painful mucosal tears in the EoE esophagus. The pathogenesis of tissue remodeling in EoE is not completely understood, but emerging studies suggest that secretory products of eosinophils and mast cells, as well as cytokines produced by other inflammatory cells, epithelial cells, and stromal cells in the esophagus, all contribute to the process. Interleukin (IL)-4 and IL-13, Th2 cytokines overproduced in allergic disorders, have direct profibrotic and remodeling effects in EoE. The EoE esophagus exhibits increased expression of transforming growth factor (TGF)-?1, which is a potent activator of fibroblasts and a strong inducer of epithelial-mesenchymal transition. In addition, IL-4, IL-13, and TGF-? all have a role in regulating periostin, an extracellular matrix protein that might influence remodeling by acting as a ligand for integrins, by its effects on eosinophils or by activating fibrogenic genes in the esophagus. Presently, few treatments have been shown to affect the tissue remodeling that causes EoE complications. This report reviews the potential roles of fibroblasts, eosinophils, mast cells, and profibrotic cytokines in esophageal remodeling in EoE and identifies potential targets for future therapies that might prevent EoE complications. PMID:23019192

Cheng, Edaire; Souza, Rhonda F.

2012-01-01

168

Use of Preclinical Data for Selection of a Phase II\\/III Dose for Evernimicin and Identification of a Preclinical MIC Breakpoint  

Microsoft Academic Search

One of the most challenging issues in the design of phase II\\/III clinical trials of antimicrobial agents is dose selection. The choice is often based on preclinical data from pharmacokinetic (PK) studies with animals and healthy volunteers but is rarely linked directly to the target organisms except by the MIC, an in vitro measure of antimicrobial activity with many limitations.

G. L. Drusano; S. L. Preston; C. Hardalo; R. Hare; C. Banfield; D. Andes; O. Vesga; W. A. Craig

2001-01-01

169

Eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia.  

PubMed

Esophageal atresia (EA) is defined as a discontinuity of the lumen of the esophagus repaired soon after birth. Dysphagia is a common symptom in these patients, usually related to stricture, dysmotility or peptic esophagitis. We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of Eosinophilic esophagitis (EoE) was made, ages ranging from 9 to 16 years. Although our patients were on acid suppression years after their EA repair, they presented with acute worsening of dysphagia. Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with EoE. Two of 4 patients improved symptomatically with the topical steroids. It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies. One of our patients developed recurrent anastomotic strictures that improved with the treatment of the EoE. A previous case report linked the recurrence of esophageal strictures in patients with EA repair with EoE. Once the EoE was treated the strictures resolved. On the other hand, based on our observation, EoE could be present in patients without recurrent anastomotic strictures. There appears to be a spectrum in the disease process. We are suggesting that EoE is a frequent concomitant problem in patients with history of congenital esophageal deformities, and for this reason any of these patients with refractory reflux symptoms or dysphagia (with or without anastomotic stricture) may benefit from an endoscopic evaluation with biopsies to rule out EoE. PMID:25548504

Kassabian, Sirvart; Baez-Socorro, Virginia; Sferra, Thomas; Garcia, Reinaldo

2014-12-21

170

Esophageal dilations in eosinophilic esophagitis: A single center experience  

PubMed Central

AIM: To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the safety of dilation in patients with eosinophilic esophagitis (EoE). METHODS: The medical records of all patients diagnosed with EoE between January 2002 and July 2010 were retrospectively reviewed. Esophageal biopsies were reexamined by an experienced pathologist to confirm the diagnosis (? 15 eos/hpf per current guidelines). Patients were divided into 2 groups: patients who did not receive dilation therapy and those who did. Demographics, clinical history, the use of pharmacologic therapy, endoscopic and pathology findings, and the number of biopsies and dilations carried out, if any, and their locations were recorded for each patient. The dilation group was further examined based on the interval between diagnosis and dilation, and whether or not a complication occurred. RESULTS: Sixty-one patients were identified with EoE and 22 (36%) of them underwent esophageal dilations for stricture/narrowing. The peak eos/hpf was significantly higher in patients who received a dilation (P = 0.04). Four (18% of pts.) minor complications occurred: deep mucosal tear 1, and small mucosal tears 3. There were no cases of esophageal perforations. Higher peak eos/hpf counts were not associated with increased risk of complications. CONCLUSION: Esophageal dilation appears to be a safe procedure in EoE patients, carrying a low complication rate. No correlation was found between the peak of eosinophil count and complication rate. Complications can occur independently of the histologic features. The long-term outcome of EoE treatment, with or without dilation, needs to be determined. PMID:25071351

Ukleja, Andrew; Shiroky, Jennifer; Agarwal, Amitesh; Allende, Daniela

2014-01-01

171

Eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia  

PubMed Central

Esophageal atresia (EA) is defined as a discontinuity of the lumen of the esophagus repaired soon after birth. Dysphagia is a common symptom in these patients, usually related to stricture, dysmotility or peptic esophagitis. We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of Eosinophilic esophagitis (EoE) was made, ages ranging from 9 to 16 years. Although our patients were on acid suppression years after their EA repair, they presented with acute worsening of dysphagia. Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with EoE. Two of 4 patients improved symptomatically with the topical steroids. It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies. One of our patients developed recurrent anastomotic strictures that improved with the treatment of the EoE. A previous case report linked the recurrence of esophageal strictures in patients with EA repair with EoE. Once the EoE was treated the strictures resolved. On the other hand, based on our observation, EoE could be present in patients without recurrent anastomotic strictures. There appears to be a spectrum in the disease process. We are suggesting that EoE is a frequent concomitant problem in patients with history of congenital esophageal deformities, and for this reason any of these patients with refractory reflux symptoms or dysphagia (with or without anastomotic stricture) may benefit from an endoscopic evaluation with biopsies to rule out EoE.

Kassabian, Sirvart; Baez-Socorro, Virginia; Sferra, Thomas; Garcia, Reinaldo

2014-01-01

172

Gene-Expression Signatures Can Distinguish Gastric Cancer Grades and Stages  

Microsoft Academic Search

Microarray gene-expression data of 54 paired gastric cancer and adjacent noncancerous gastric tissues were analyzed, with the aim to establish gene signatures for cancer grades (well-, moderately-, poorly- or un-differentiated) and stages (I, II, III and IV), which have been determined by pathologists. Our statistical analysis led to the identification of a number of gene combinations whose expression patterns serve

Juan Cui; Fan Li; Guoqing Wang; Xuedong Fang; J. David Puett; Ying Xu

2011-01-01

173

The Changing Face of Esophageal Cancer  

PubMed Central

The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction. PMID:24281163

Melhado, Rachel E.; Alderson, Derek; Tucker, Olga

2010-01-01

174

Esophagitis in distressed infants: Poor diagnostic agreement between esophageal pH monitoring and histopathologic findings  

Microsoft Academic Search

Objectives: Our purpose was to study the relation between gastroesophageal reflux (GER) and esophagitis in infants with persistent distress. Study design: Infants (n = 125, 79 boys; median age, 4.2 months) with persistent distress and clinical symptoms suggestive of GER and esophagitis were retrospectively studied. All had undergone esophageal 24-hour pH monitoring and had upper gastrointestinal biopsy specimens taken. Results:

Ralf G. Heine; Donald J. S. Cameron; Chung W. Chow; David J. Hill; Anthony G. Catto-Smith

2002-01-01

175

[Esophageal mucocele: report of 2 pediatric cases].  

PubMed

Two cases of esophageal mucocele in pediatric patients are reported: two children of 5 and 9 years respectively underwent surgical isolation of the esophagus and esophagocoloplasty for caustic stenosis related to accidental ingestion of caustic soda. Clinical pattern of mediastinal compression was proved with cervical fistulous tract in one case. In both cases, thoracic computed tomography was a sensitive imaging method to demonstrate the mucocele and its extension. Esophageal mucocele is rarely described in children, especially following esophageal corrosive stricture. PMID:11965151

Achour-Arifa, N; Tlili-Graiess, K; El Ouni, F; Mrad-Dali, K; Derbel, F; Yacoubi, M T; Gharbi-Jemni, H; Haj Hmida, R B; Jeddi, M

2002-01-01

176

Brain abscess after esophageal dilatation: case report.  

PubMed

Brain abscess formation is a serious disease often seen as a complication to other diseases and to procedures. A rare predisposing condition is dilatation therapy of esophageal strictures. A case of brain abscess formation after esophageal dilatations is presented. A 59-year-old woman was admitted with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case illustrates the possible association between therapeutic esophageal dilatation and the risk of brain abscess formation. PMID:17710371

Gaïni, S; Grand, M; Michelsen, J

2008-02-01

177

Corrosive Esophagitis Caused by Ingestion of Picosulfate  

PubMed Central

Corrosive esophagitis is characterized by caustic injury due to the ingestion of chemical agents, mainly alkaline substances such as detergents. Esophageal bleeding, perforation, or stricture can be worsened by high-degree corrosive esophagitis. Picosulfate is a commonly used laxative frequently administered for bowel preparation before colonoscopy or colon surgery. Picosulfate powder should be completely dissolved in water before ingestion because the powder itself may cause chemical burning of the esophagus and stomach. Here, we report a case of corrosive esophagitis due to the ingestion of picosulfate powder that was not completely dissolved in water. PMID:25674529

Seo, Jae Yong; Kang, Ho Suk; Kim, Seong Eun; Park, Ji Won; Moon, Sung Hoon; Kim, Jong Hyeok; Park, Choong Kee

2015-01-01

178

Outcome of Photodynamic Therapy for Early Esophageal Cancer  

PubMed Central

Background/Aims Endoscopic treatment as an alternative to surgery has become increasingly popular for improving the quality of life. Although photodynamic therapy (PDT) has been used for the endoscopic treatment of digestive cancer, its curative efficacy remains unclear. We evaluated the curative efficacy of PDT in superficial esophageal cancer in inoperable patients. Methods Ten male patients with histologically proven early esophageal cancer (surgery was contraindicated for age > 80 years, surgery was contraindicated, Karnofsky performance status of at least 30%, or refusal of surgery) were intravenously injected with a hematoporphyrin derivative (2 mg/kg), and PDT was performed 48 h later. The response to treatment was assessed by gastroscopy with biopsies. Results The mean follow-up period was 27.6 months (range, 9.6-58.7 months). Endoscopic ultrasonography revealed that all ten cases were at tumor stage T1. Complete remission (CR) to initial and subsequent PDT was observed in all patients. For the CR cases, the recurrence rate was 10% (1/10) and the time from initial PDT to recurrence was 9.6 months. Conclusions For patients in whom surgery is risky or refused, PDT may represent an acceptable alternative treatment modality, especially for superficial esophageal cancer without lymph node metastasis. However, a study involving long-term follow-up in a large population is needed for confirmation. PMID:20485628

Kim, Wan Jung; Cho, Joo Young; Lee, Joon Seong; Lee, Moon Sung; Shim, Chan Sup

2007-01-01

179

Development of a Multicomponent Prediction Model for Acute Esophagitis in Lung Cancer Patients Receiving Chemoradiotherapy  

SciTech Connect

Purpose: To construct a model for the prediction of acute esophagitis in lung cancer patients receiving chemoradiotherapy by combining clinical data, treatment parameters, and genotyping profile. Patients and Methods: Data were available for 273 lung cancer patients treated with curative chemoradiotherapy. Clinical data included gender, age, World Health Organization performance score, nicotine use, diabetes, chronic disease, tumor type, tumor stage, lymph node stage, tumor location, and medical center. Treatment parameters included chemotherapy, surgery, radiotherapy technique, tumor dose, mean fractionation size, mean and maximal esophageal dose, and overall treatment time. A total of 332 genetic polymorphisms were considered in 112 candidate genes. The predicting model was achieved by lasso logistic regression for predictor selection, followed by classic logistic regression for unbiased estimation of the coefficients. Performance of the model was expressed as the area under the curve of the receiver operating characteristic and as the false-negative rate in the optimal point on the receiver operating characteristic curve. Results: A total of 110 patients (40%) developed acute esophagitis Grade {>=}2 (Common Terminology Criteria for Adverse Events v3.0). The final model contained chemotherapy treatment, lymph node stage, mean esophageal dose, gender, overall treatment time, radiotherapy technique, rs2302535 (EGFR), rs16930129 (ENG), rs1131877 (TRAF3), and rs2230528 (ITGB2). The area under the curve was 0.87, and the false-negative rate was 16%. Conclusion: Prediction of acute esophagitis can be improved by combining clinical, treatment, and genetic factors. A multicomponent prediction model for acute esophagitis with a sensitivity of 84% was constructed with two clinical parameters, four treatment parameters, and four genetic polymorphisms.

De Ruyck, Kim, E-mail: kim.deruyck@UGent.be [Department of Basic Medical Sciences, Ghent University, Ghent (Belgium); Sabbe, Nick [Department of Applied Mathematics, Biometrics and Process Control, Ghent University, Ghent (Belgium); Oberije, Cary [Department of Radiation Oncology (MAASTRO Clinic), Research Institute of Growth and Development, Maastricht University Medical Center, Maastricht (Netherlands); Vandecasteele, Katrien [Department of Radiation Oncology, Ghent University Hospital, Ghent (Belgium); Thas, Olivier [Department of Applied Mathematics, Biometrics and Process Control, Ghent University, Ghent (Belgium); De Ruysscher, Dirk; Lambin, Phillipe [Department of Radiation Oncology (MAASTRO Clinic), Research Institute of Growth and Development, Maastricht University Medical Center, Maastricht (Netherlands); Van Meerbeeck, Jan [Department of Respiratory Medicine, Ghent University Hospital, Ghent (Belgium); De Neve, Wilfried [Department of Radiation Oncology, Ghent University Hospital, Ghent (Belgium); Thierens, Hubert [Department of Basic Medical Sciences, Ghent University, Ghent (Belgium)

2011-10-01

180

Esophageal inflammatory pseudotumor mimicking malignancy.  

PubMed

A 54-year-old man with a complaint of dysphagia was found to have a prominent stricture in the proximal esophagus. A biopsy of the stenotic area indicated sarcoma, leading to subtotal esophagectomy. The surgically removed esophagus demonstrated a well-defined intramural mass, consisting of a mixture of fibroblastic cells with bland cytological appearances and inflammatory cells. Reflux esophagitis which was present distal to the stricture seemed to play a role in the development of this inflammatory pseudotumor. PMID:11201363

Kurihara, K; Mizuseki, K; Ichikawa, M; Okada, K; Miyata, Y

2001-01-01

181

Distal esophageal spasm: an update.  

PubMed

Distal esophageal spasm (DES) is an esophageal motility disorder that presents clinically with chest pain and/or dysphagia and is defined manometrically as simultaneous contractions in the distal (smooth muscle) esophagus in ?20% of wet swallows (and amplitude contraction of ?30 mmHg) alternating with normal peristalsis. With the introduction of high resolution esophageal pressure topography (EPT) in 2000, the definition of DES was modified. The Chicago classification proposed that the defining criteria for DES using EPT should be the presence of at least two premature contractions (distal latency<4.5 s) in a context of normal EGJ relaxation. The etiology of DES remains insufficiently understood, but evidence links nitric oxide (NO) deficiency as a culprit resulting in a disordered neural inhibition. GERD frequently coexists in DES, and its role in the pathogenesis of symptoms needs further evaluation. There is some evidence from small series that DES can progress to achalasia. Treatment remains challenging due in part to lack of randomized placebo-controlled trials. Current treatment agents include nitrates (both short and long acting), calcium-channel blockers, anticholinergic agents, 5-phosphodiesterase inhibitors, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation. Acid suppression therapy is frequently used, but clinical outcome trials to support this approach are not available. Injection of botulinum toxin in the distal esophagus may be effective, but further data regarding the development of post-injection gastroesophageal reflux need to be assessed. Heller myotomy combined with fundoplication remains an alternative for the rare refractory patient. Preliminary studies suggest that the newly developed endoscopic technique of per oral endoscopic myotomy (POEM) may also be an alternative treatment modality. PMID:23892829

Achem, Sami R; Gerson, Lauren B

2013-09-01

182

Vitiligo Associated with Esophageal Adenocarcinoma  

PubMed Central

Vitiligo is a disease that results in depigmented areas in the skin. It may develop at any age but the average age at onset is 20 years. Association of vitiligo and melanoma has been commonly reported, but malignancies other than melanoma have been rarely associated with vitiligo. We report a 73-year-old patient with new onset vitiligo who developed esophageal adenocarcinoma in the following years. PMID:23671783

Asilian, Ali; Momeni, Iman; Khosravani, Parastou

2013-01-01

183

Spontaneous esophageal-pleural fistula.  

PubMed

Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed. PMID:22084548

Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

2011-10-01

184

Spontaneous esophageal-pleural fistula  

PubMed Central

Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed. PMID:22084548

Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

2011-01-01

185

High expression of the stem cell marker nestin is an adverse prognostic factor in WHO grade II-III astrocytomas and oligoastrocytomas  

PubMed Central

Infiltrating astrocytomas and oligoastrocytomas of low to anaplastic grade (WHO grades II and III), in spite of being associated with a wide range of clinical outcomes, can be difficult to subclassify and grade by the current histopathologic criteria. Unlike oligodendrogliomas and anaplastic oligodendrogliomas that can be identified by the 1p/19q codeletion and the more malignant glioblastomas (WHO grade IV astrocytomas) that can be diagnosed solely based on objective features on routine hematoxylin and eosin sections, no such objective criteria exist for the subclassification of grade II-III astrocytomas and oligoastrocytomas (A+OA II-III). In this study, we evaluated the prognostic and predictive value of the stem cell marker nestin in adult A+OA II-III (n=50) using immunohistochemistry and computer-assisted analysis on tissue microarrays. In addition, the correlation between nestin mRNA level and total survival was analyzed in the NCI Rembrandt database. The results showed that high nestin expression is a strong adverse prognostic factor for total survival (p=0.0004). The strength of the correlation was comparable to but independent of the isocitrate dehydrogenase 1/2 (IDH 1/2) mutation status. Histopathological grading and subclassification did not correlate significantly with outcome, although the interpretation of this finding is limited by the fact that grade III tumors were treated more aggressively than grade II tumors. These results suggest that nestin level and IDH 1/2 mutation status are strong prognostic features in A+OA II-III and possibly more helpful for treatment planning than routine histopathological variables such as oligodendroglial component (astrocytoma vs. oligoastrocytoma) and WHO grade (grade II vs. III). PMID:24519516

Hatanpaa, Kimmo J.; Foong, Chan; Raisanen, Jack M.; Oliver, Dwight; Hiemenz, Matthew C.; Burns, Dennis K.; White, Charles L.; Whitworth, L. Anthony; Mickey, Bruce; Stegner, Martha; Habib, Amyn A.; Fink, Karen; Maher, Elizabeth A.; Bachoo, Robert M.

2015-01-01

186

arXiv:cs/0703150v2[cs.NA]29Jan2009 1 Type-II/III DCT/DST algorithms  

E-print Network

arXiv:cs/0703150v2[cs.NA]29Jan2009 1 Type-II/III DCT/DST algorithms with reduced number cosine trans- form (DCT) and discrete sine transform (DST), of types II and III, that achieve a lower for N = 8 by Arai et al. These results are derived by considering the DCT to be a special case of a DFT

Leiserson, Charles E.

187

[Esophageal injury following blunt thoracic trauma. A case report and review of the literature].  

PubMed

The aim of this article was to raise the awareness of the difficulties physicians face in the diagnosis and treatment of esophageal perforation following blunt thoracic trauma. We present a case of esophagus perforation following blunt chest trauma in the course of a motorcycle accident. Within 24 h the patient was admitted to the University hospital, and presented with progressive pain, subfebrile temperature, leukocytosis and pneumomediastinum. Emergency surgery revealed extensive esophageal lesions. A two-stage surgical approach was chosen with initial resection and temporary closure of the esophagus. After 2 months the integrity of the esophagus could be restored without complications. PMID:23052701

Torba, M; Baumbach, S F; Gjata, A; Buci, S; Faber, E; Subashi, K

2012-12-01

188

Achalasia: a risk factor that must not be forgotten for esophageal squamous cell carcinoma.  

PubMed

Alcohol and tobacco abuse are the main risk factors for esophageal squamous cell carcinoma (ESCC), but other conditions that induce chronic irritation of the esophageal mucosa have also been attributed to it. For example, long-standing achalasia increases 16 times the risk of developing ESCC. We report the case of a patient with long-standing achalasia who developed ESCC. Although this complication is infrequent, it should be remembered by clinicians who treat patients with achalasia to detect early stages cancer. PMID:25564630

Ríos-Galvez, Shareni; Meixueiro-Daza, Arturo; Remes-Troche, Jose Maria

2015-01-01

189

Successful repair of an aortoesophageal fistula with aneurysm from esophageal diverticulum.  

PubMed

Aortoesophageal fistula is a rare, frequently fatal, cause of upper gastrointestinal bleeding, and there are few reported survivors of it. We report a successful surgical case of aortoesophageal fistula associated with an infective thoracic aortic aneurysm. The patient had been diagnosed as having an esophageal diverticulum 8 months before admission. The aortoesophageal fistula was completely resected, followed by esophagojejunum anastomosis and patch closure for the entry of the aneurysm and omental coverage to the wall of the descending aorta in one stage. In this case, esophageal diverticulum was diagnosed before the development of an aortoesophageal fistula associated with an aneurysm. PMID:11845889

Yasuda, Fuyuhiko; Shimono, Takatsugu; Tonouchi, Hitoshi; Shimpo, Hideto; Yada, Isao

2002-02-01

190

Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification  

PubMed Central

Recent developments in image-enhancement technology have enabled clear visualization of the microvascular structure of the esophageal mucosa. In particular, intrapapillary capillary loops (IPCLs) are observed as brown loops on magnification endoscopy with narrow-band imaging (NBI). IPCLs demonstrate characteristic morphological changes according to the structural irregularity of esophageal epithelium and cancer infiltration, summarized in the IPCL classification. In this review, the process from the first endoscopic description of IPCLs to the eventual development of the IPCL classification is described and discussed, particularly focusing on early stage squamous cell carcinoma of the esophagus. PMID:25608626

Inoue, Haruhiro; Kaga, Makoto; Ikeda, Haruo; Sato, Chiaki; Sato, Hiroki; Minami, Hitomi; Santi, Esperanza Grace; Hayee, Bu’Hussain; Eleftheriadis, Nikolas

2015-01-01

191

Radiation Therapy for Esophageal Cancer in Japan: Results of the Patterns of Care Study 1999-2001  

SciTech Connect

Purpose: To describe patient characteristics and the process of radiotherapy (RT) for patients with esophageal cancer treated between 1999 and 2001 in Japan. Methods and Materials: The Japanese Patterns of Care Study (PCS) Working Group conducted a third nationwide survey of 76 institutions. Detailed information was accumulated on 621 patients with thoracic esophageal cancer who received RT. Results: The median age of patients was 68 years. Eighty-eight percent were male, and 12% were female. Ninety-nine percent had squamous cell carcinoma histology. Fifty-five percent had the main lesion in the middle thoracic esophagus. Fourteen percent had clinical Stage 0-I disease, 32% had Stage IIA-IIB, 43% had Stage III, and 10% had Stage IV disease. Chemotherapy was given to 63% of patients; 39% received definitive chemoradiotherapy (CRT) without surgery and 24% pre- or postoperative CRT. Sixty-two percent of the patients aged {>=}75 years were treated with RT only. Median total dose of external RT was 60 Gy for definitive CRT patients, 60 Gy for RT alone, and 40 Gy for preoperative CRT. Conclusions: This PCS describes general aspects of RT for esophageal cancer in Japan. Squamous cell carcinoma accounted for the majority of patients. The standard total external RT dose for esophageal cancer was higher in Japan than in the United States. Chemoradiotherapy had become common for esophageal cancer treatment, but patients aged {>=}75 years were more likely to be treated by RT only.

Kenjo, Masahiro [Division of Radiation Oncology, Hiroshima University Hospital, Hiroshima (Japan)], E-mail: kenjom@hiroshima-u.ac.jp; Uno, Takashi [Department of Radiation Oncology, Chiba University, Graduate School of Medicine, Chiba (Japan); Murakami, Yuji; Nagata, Yasushi [Division of Radiation Oncology, Hiroshima University Hospital, Hiroshima (Japan); Oguchi, Masahiko [Department of Medical Engineering, Osaka University Medical School, Osaka (Japan); Saito, Susumu; Numasaki, Hodaka; Teshima, Teruki [Department of Radiation Oncology, Cancer Institute Ariake Hospital, Tokyo (Japan); Mitsumori, Michihide [Department of Radiation Oncology, Kyoto University, Graduate School of Medicine, Kyoto (Japan)

2009-10-01

192

A Systematic Review of the Risk of Perforation During Esophageal Dilation for Patients with Eosinophilic Esophagitis  

PubMed Central

Background Eosinophilic esophagitis (EoE) is associated with tissue remodeling that can result in esophageal mucosal fragility, and esophageal dilation for patients with EoE is known to cause painful mucosal lacerations. Clinicians have been admonished that patients with EoE may be exceptionally predisposed to perforation with esophageal dilation, a notion supported primarily by case reports. We have conducted a systematic review of literature on esophageal dilation in EoE in an attempt to better define the risk of perforation. Methods We searched PubMed and abstracts presented at the annual scientific meetings of the American Gastroenterological Association and the American College of Gastroenterology to identify reports on esophageal dilation in EoE. We analyzed reports meeting the following criteria: (1) the diagnosis was established from esophageal biopsy specimens revealing ?15 eosinophils/hpf, (2) esophageal dilation was described, (3) esophageal perforations described were the result of esophageal dilation. Results We identified 18 reports for inclusion in our systematic review. The studies comprised 468 patients who underwent a total of 671 endoscopic dilations. Esophageal mucosal tears were described in most cases, but there was only one perforation among the 671 dilations (0.1%). Conclusions Our systematic review does not reveal an inordinate frequency of esophageal perforation from dilation in patients with EoE, and it is not clear that dilation is any more hazardous for patients with EoE than for patients with other causes of esophageal stricture. Although esophageal dilation must be performed with caution in all patients, the risk of perforation in EoE appears to have been exaggerated. PMID:20238250

Jacobs, John William

2011-01-01

193

Acid Reflux Directly Causes Sleep Disturbances in Rat with Chronic Esophagitis  

PubMed Central

Background & Aims Gastroesophageal reflux disease (GERD) is strongly associated with sleep disturbances. Proton pump inhibitor (PPI) therapy improves subjective but not objective sleep parameters in patients with GERD. This study aimed to investigate the association between GERD and sleep, and the effect of PPI on sleep by using a rat model of chronic acid reflux esophagitis. Methods Acid reflux esophagitis was induced by ligating the transitional region between the forestomach and the glandular portion and then wrapping the duodenum near the pylorus. Rats underwent surgery for implantation of electrodes for electroencephalogram and electromyogram recordings, and they were transferred to a soundproof recording chamber. Polygraphic recordings were scored by using 10-s epochs for wake, rapid eye movement sleep, and non-rapid eye movement (NREM) sleep. To examine the role of acid reflux, rats were subcutaneously administered a PPI, omeprazole, at a dose of 20 mg/kg once daily. Results Rats with reflux esophagitis presented with several erosions, ulcers, and mucosal thickening with basal hyperplasia and marked inflammatory infiltration. The reflux esophagitis group showed a 34.0% increase in wake (232.2±11.4 min and 173.3±7.4 min in the reflux esophagitis and control groups, respectively; p<0.01) accompanied by a reduction in NREM sleep during light period, an increase in sleep fragmentation, and more frequent stage transitions. The use of omeprazole significantly improved sleep disturbances caused by reflux esophagitis, and this effect was not observed when the PPI was withdrawn. Conclusions Acid reflux directly causes sleep disturbances in rats with chronic esophagitis. PMID:25215524

Nakahara, Kenichi; Fujiwara, Yasuhiro; Tsukahara, Takuya; Yamagami, Hirokazu; Tanigawa, Tetsuya; Shiba, Masatsugu; Tominaga, Kazunari; Watanabe, Toshio; Urade, Yoshihiro; Arakawa, Tetsuo

2014-01-01

194

Role of endoscopy in the management of esophageal diseases.  

PubMed

Endoscopy plays a major role in diseases of the esophagus. Endoscopic findings alone can suggest or confirm a variety of diagnoses, especially with newer imaging modalities, which can be confirmed by endoscopic biopsy. Endoscopic ultrasound allows accurate staging for the management of esophageal malignancies. In the area of therapeutics, endoscopy allows for dilation of strictures, resection and ablation of premalignant lesions and placement of stents for benign and malignant diseases. This article will summarize the latest advances in diagnostic and therapeutic endoscopy. PMID:19047982

Baron, T H

2008-12-01

195

Epigenetics in the Pathogenesis of Esophageal Adenocarcinoma.  

PubMed

Epigenetic influences, such as DNA methylation, histone acetylation, and up-regulation/down-regulation of genes by microRNAs, change the genetic makeup of an individual without affecting DNA base-pair sequences. Indeed, epigenetic changes play an integral role in the progression from normal esophageal mucosa to Barrett's esophagus to esophageal adenocarcinoma via dysplasia-metaplasia-neoplasia sequence. Many genes involved in esophageal adenocarcinoma display hypermethylation, leading to their down-regulation. The classes of these genes include cell cycle control, DNA and growth factor repair, tumor suppressors, antimetastasis, Wnt-related genes, and proapoptotic genes. Histone acetylation in the pathophysiology of esophageal diseases has not been thoroughly investigated, and its critical role in the development of esophageal adenocarcinoma is less defined. Many microRNAs have been associated with the development of Barrett's esophagus and esophageal adenocarcinoma. Here, we critically addressed the specific steps most closely influenced by microRNAs in the progression from Barrett's esophagus to esophageal adenocarcinoma. However, microRNAs can target up to hundreds of genes, making it difficult to correlate directly with a given phenotype of the disease. Esophageal adenocarcinoma progressing from premalignant condition of Barrett's esophagus carries an extremely poor prognosis. Risk stratification for patients based on their epigenetic profiles may be useful in providing more targeted and directed treatment to patients. PMID:25388215

Kailasam, Aparna; Mittal, Sumeet K; Agrawal, Devendra K

2014-11-12

196

Toll-Like Receptors in Esophageal Cancer  

PubMed Central

Esophageal squamous cell carcinoma and esophageal adenocarcinoma are cancers of high mortality. EAC develops through Barrett’s esophagus (BE) and columnar dysplasia, preceded by gastro-esophageal reflux disease. The risk of esophageal squamous cell carcinoma is increased by smoking and alcohol consumption. New treatment options for esophageal cancer are desperately needed. Toll-like receptors (TLRs) play a central role in mammalian immunity and cancer. TLRs are activated by microbial components, such as lipopolysaccharide, flagellin, DNA, and RNA, as well as endogenous ligands, including heat-shock proteins and endogenous DNA. This review summarizes the studies on TLRs in esophageal squamous cell carcinoma and EAC. It has been shown that TLRs 1–10 are expressed in the normal esophagus. In esophageal squamous cell carcinoma, TLRs3, 4, 7, and 9 have been studied, showing associations to aggressive disease properties. In BE and EAC, only TLRs4, 5, and 9 have been studied. In the review, we discuss the implications of TLRs in esophageal cancer. PMID:24847326

Kauppila, Joonas H.; Selander, Katri S.

2014-01-01

197

A novel intermediate mucolipidosis II/III?? caused by GNPTAB mutation in the cytosolic N-terminal domain.  

PubMed

Mucolipidosis (ML) II and ML III?/? are allelic autosomal recessive metabolic disorders due to mutations in GNPTAB. The gene encodes the enzyme UDP-GlcNAc-1-phosphotransferase (GNPT), which is critical to proper trafficking of lysosomal acid hydrolases. The ML phenotypic spectrum is dichotomous. Criteria set for defining ML II and ML III?/? are inclusive for all but the few patients with phenotypes that span the archetypes. Clinical and biochemical findings of the 'intermediate' ML in eight patients with the c.10A>C missense mutation in GNPTAB are presented to define this intermediate ML and provide a broader insight into ML pathogenesis. Extensive clinical information, including radiographic examinations at various ages, was obtained from a detailed study of all patients. GNPTAB was sequenced in probands and parents. GNPT activity was measured and cathepsin D sorting assays were performed in fibroblasts. Intermediate ML patients who share the c.10A>C/p.K4Q mutation in GNPTAB demonstrate a distinct, consistent phenotype similar to ML II in physical and radiographic features and to ML III?/? in psychomotor development and life expectancy. GNPT activity is reduced to 7-12% but the majority of newly synthesized cathepsin D remains intracellular. The GNPTAB c.10A>C/p.K4Q missense allele results in an intermediate ML II/III with distinct clinical and biochemical characteristics. This delineation strengthens the utility of the discontinuous genotype-phenotype correlation in ML II and ML III?/? and prompts additional studies on the tissue-specific pathogenesis in GNPT-deficient ML. PMID:24045841

Leroy, Jules G; Sillence, David; Wood, Tim; Barnes, Jarrod; Lebel, Robert Roger; Friez, Michael J; Stevenson, Roger E; Steet, Richard; Cathey, Sara S

2014-05-01

198

Unusual Presentation of a Metastatic Esophageal Carcinoma  

PubMed Central

Esophageal cancer most commonly presents with upper digestive symptoms such as dysphagia. Lymph nodes are among the most common metastatic sites of this type of cancer. We report the case of a 53-year-old man presenting with unusual sole presenting features of esophageal cancer. The patient sought medical attention for abdominal pain without dysphagia, which was first investigated with an abdominal computed tomography scan. A large abdominal mass was discovered on imaging. Biopsies of this mass were in keeping with esophageal squamous cell cancer. With this finding, gastroscopy was performed, confirming the presence of primary esophageal cancer. This is a rare presentation of esophageal cancer without upper gastrointestinal symptoms. This case reinforces the value of biopsy for any neoplastic mass, especially in a context of unusual symptoms. PMID:22679417

Orlicka, Katarzyna; Maynard, Stéphanie; Bouin, Mickael

2012-01-01

199

Phase-contrast X-ray CT Imaging of Esophagus and Esophageal Carcinoma  

PubMed Central

The electron density resolution is 1000 times higher for synchrotron-radiation phase-contrast CT imaging than conventional X-ray absorption imaging in light elements, with which high-resolution X-ray imaging of biological soft tissue can be achieved. In the present study, we used phase-contrast X-ray CT to investigate human resected esophagus and esophageal carcinoma specimens. This technology revealed the three-layer structure of the esophageal wall-- mucous, submucosa and muscular layers. The mucous and muscular layers were clearly separated by a loose submucosa layer with a honeycomb appearance. The surface of the mucous layer was smooth. In esophageal carcinoma, because of tumor tissue infiltration, the submucosa layer was absent, which indicated destruction of the submucosa. The boundary between normal tissue and tumor was comparatively fuzzy, the three-layer structure of the esophageal wall was indistinct. The surface of the mucous layer was rugose. The technology might be helpful in tumor staging of esophageal carcinoma. PMID:24939041

Zhang, Jianfa; Tian, Dongping; Lin, Runhua; zhou, Guangzhao; Peng, Guanyun; Su, Min

2014-01-01

200

Endoscopic management of esophageal varices  

PubMed Central

The rupture of gastric varices results in variceal hemorrhage, which is one the most lethal complications of cirrhosis. Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the varix. The two principal methods available for esophageal varices are endoscopic sclerotherapy (EST) and band ligation (EBL). The advantages of EST are that it is cheap and easy to use, and the injection catheter fits through the working channel of a diagnostic gastroscope. Endoscopic variceal ligation obliterates varices by causing mechanical strangulation with rubber bands. The following review aims to describe the utility of EBL and EST in different situations, such as acute bleeding, primary and secondary prophylaxis PMID:22816012

Poza Cordon, Joaquin; Froilan Torres, Consuelo; Burgos García, Aurora; Gea Rodriguez, Francisco; Suárez de Parga, Jose Manuel

2012-01-01

201

Endoscopic management of esophageal varices.  

PubMed

The rupture of gastric varices results in variceal hemorrhage, which is one the most lethal complications of cirrhosis. Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the varix. The two principal methods available for esophageal varices are endoscopic sclerotherapy (EST) and band ligation (EBL). The advantages of EST are that it is cheap and easy to use, and the injection catheter fits through the working channel of a diagnostic gastroscope. Endoscopic variceal ligation obliterates varices by causing mechanical strangulation with rubber bands. The following review aims to describe the utility of EBL and EST in different situations, such as acute bleeding, primary and secondary prophylaxis. PMID:22816012

Poza Cordon, Joaquin; Froilan Torres, Consuelo; Burgos García, Aurora; Gea Rodriguez, Francisco; Suárez de Parga, Jose Manuel

2012-07-16

202

Efficacy and histopathological esophageal wall damage of biodegradable esophageal stents for treatment of severe refractory esophageal anastomotic stricture in a child with long gap esophageal atresia.  

PubMed

A case in which a self-expandable biodegradable (BD) esophageal stent was used for a refractory esophageal anastomotic stricture (EAS) in a 5-year-old female is presented. The patient underwent closure of a tracheoesophageal fistula and gastrostomy in the neonatal period. Esophagoesophagostomy was performed at 18 months of age after a multistaged extrathoracic esophageal elongation procedure. The patient developed refractory EAS and required repeated esophageal balloon dilation. Four sessions of esophageal BD stenting were performed from the age of 5-8 years. Each BD stenting allowed her to eat chopped food, but the anastomotic stricture recurred 4-7 months after the procedure. No major complications were observed, though transient chest pain and dysphagia were observed after each stenting. Finally, at 8 years of age, EAS resection and esophagoesophageal anastomosis were performed. The resected specimens showed thickened scar formation at the EAS lesion, while the degree of esophageal wall damage, both at the proximal and distal ends of the stricture, was slight. To the best of our knowledge, this is the first case report of this kind of treatment and assessment of damage to the esophageal wall microscopically. The advantages and problems of the use of BD stents in children are discussed. PMID:25399341

Okata, Yuichi; Hisamatsu, Chieko; Bitoh, Yuko; Yokoi, Akiko; Nishijima, Eiji; Maeda, Kosaku; Yoshida, Makiko; Ishida, Tsukasa; Azuma, Takeshi; Kutsumi, Hiromu

2014-12-01

203

Esophageal motility abnormalities in gastroesophageal reflux disease  

PubMed Central

Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted. PMID:24868489

Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

2014-01-01

204

Overexpression of long non-coding RNA UCA1 predicts a poor prognosis in patients with esophageal squamous cell carcinoma  

PubMed Central

Introduction: Long non-coding RNAs (lncRNAs) have been shown to have important regulatory roles in cancer biology, and the lncRNA UCA1 is upregulated in several cancers such as bladder cancer, breast cancer and colorectal cancer, however, the contributions of UCA1 to esophageal cancer remain largely unknown. Methods: Expression levels of lncRNA UCA1 in esophageal squamous cell carcinoma (ESCC) patients and esophageal cancer cell lines were evaluated by quantitative real-time PCR (qRT-PCR), and its association with overall survival of patients was analyzed by statistical analysis. Small interfering RNA was used to suppress UCA1 expression in esophageal cancer cell line. In vitro assays were conducted to further explore its underlying roles in tumor progression. Results: The relative level of UCA1 was significantly higher in ESCC tissues compared to the adjacent non-tumor tissues, and remarkably higher expression of UCA1 was found in esophageal cancer cell lines compared with the immortalized esophageal epithelial cell line NE1. The ESCC patients with higher UCA1 expression had an advanced clinical stage and a poorer prognosis than those with lower expression. In vitro assays, our data indicated that downregulation of UCA1 decrease cell proliferation, migration, and invasion ability. Conclusions: lncRNA UCA1 might be considered as a novel molecule involved in ESCC progression, which provides a potential prognostic biomarker and therapeutic target. PMID:25550835

Li, Ji-Yuan; Ma, Xin; Zhang, Can-Bin

2014-01-01

205

Updates on esophageal and gastric cancers  

PubMed Central

Esophageal and gastric cancers are both common and deadly. Patients present most often after disease progression and survival is therefore poor. Due to demographic variability and recent changes in disease incidence, much emphasis has been placed on studying risk factors for both esophageal and gastric cancers. However, with increasing understanding of these diseases, low survival rates persist and continued intensive studies are necessary to optimize treatment plans. This review article discusses updates in the evolving epidemiology, clinical presentation, risk factors, and diagnostic and treatment modalities of esophageal and gastric cancers. PMID:16718845

Gallo, Amy; Cha, Charles

2006-01-01

206

Esophageal melanocytosis in oral opium consumption.  

PubMed

Esophageal melanocytosis is a rare and benign condition, characterized by melanocytic proliferation of the esophageal squamous epithelium with heavy melanin deposition. The etiology and pathogenesis has not been exactly known but it seems to be a chronic stimulus such as gastroesophageal reflux. This condition is very rare and about 35 cases have been reported so far, most of which have been from India and Japan. Herein, we present a case of esophageal melanocytosis in a patient with long history of oral opium consumption. To the best of our knowledge, such a history has not been reported. PMID:24719715

Geramizadeh, Bita; Asadian, Fatemeh; Taghavi, Alireza

2014-01-01

207

Resection of esophageal carcinoma during pregnancy.  

PubMed

Esophageal carcinoma diagnosed during pregnancy is a rare occurrence. A 26-year-old pregnant patient was referred to our hospital with dysphagia. A thorough examination showed a tumor in the esophagus. Laparotomy, thoracotomy, and cervical exploration were performed. There are only 2 cases reported in the literature about esophageal carcinoma diagnosed during pregnancy and treated surgically. However, ethical dilemmas arise in managing such situations. Here we report a case of esophageal squamous cell carcinoma diagnosed at 27 weeks of gestation in which surgical resection was performed successfully. PMID:25555961

?ahin, Murat; Kocaman, Gökhan; Özkan, Murat; Yüksel, Cabir; Enön, Serkan; Kutlay, Hakan

2015-01-01

208

Association of Kruppel-like factor 4 expression with the prognosis of esophageal squamous cell carcinoma patients  

PubMed Central

Objective: To investigate the association of Kruppel-like factor 4 (KLF4) expressions with the prognosis of esophageal squamous cell carcinoma (SCC) patients. Methods: Ninety-eight cases of esophageal carcinoma patients were enrolled. The expression of KLF4 in the esophageal SCC and normal esophageal mucosa tissues were examined by immunohistochemistry. The correlations between the expression of KLF4 protein and patients’ clinical characteristics and prognosis were analyzed. Results: We observed higher expressed KLF4 in normal esophageal mucosa tissues than esophageal SCC tissues, with positive rate of 82.7% (81/98) and 43.8% (43/98) respectively. In patients with lymphatic metastasis, the positive rate of KLF4 was 24.4% (10/41), whereas it was 57.9% (33/57) in patients without lymphatic metastasis, and the difference was significant (x2 = 10.871, P = 0.001). The positive rates of KLF4 were 62.5% (5/8), 53.1% (26/49) and 29.3% (12/41) in stage I, II and III patients, respectively. There were no correlations between the expression of KLF4 and gender, age, tumor size, location, differentiation grade and infiltration depth. The 5-year survival rates and median survival times were 48.8% and 25.5%, and 55 and 26 months for the patients with KLF4 positive and negative expression, respectively. There were significant differences between the patients with KLF4 positive expression and negative expression in the 5-year survival rates and median survival times (x2 = 5.747 and 4.493, P = 0.017 and 0.034). Conclusion: KLF4 might act as a tumor suppressor in esophageal SCC and the expression status of KLF4 could be considered as a prognosis predictor for esophageal SCC patients. PMID:25400747

Ma, Ming-Quan; Zhang, Hong-Dian; Tang, Peng; Jiang, Hong-Jing; Chen, Chuan-Gui

2014-01-01

209

Incidence and specificity of antibodies to types I, II, III, IV, and V collagen in rheumatoid arthritis and other rheumatic diseases as measured by 125I-radioimmunoassay  

SciTech Connect

Antibodies to human native and denatured types I, II, III, IV, and V collagens were measured using 125I-radioimmunoassay. Mean levels of binding by sera from 30 rheumatoid arthritis patients were significantly higher than those from 20 normal subjects against all of the collagens tested. The relative antibody concentration was higher in synovial fluid than in simultaneously obtained serum. Many patients with gout or various other rheumatic diseases also had detectable anticollagen antibodies. With a few notable exceptions, the majority of the reactivity detected in all patient groups was directed against covalent structural determinants present on all of the denatured collagens, suggesting a secondary reaction to tissue injury.

Stuart, J.M.; Huffstutter, E.H.; Townes, A.S.; Kang, A.H.

1983-07-01

210

A Case of Esophageal Intramural Pseudodiverticulosis  

PubMed Central

Esophageal intramural pseudodiverticulosis (EIP) is a rare benign disease that is characterized by multiple tiny flask-shaped outpouching lesions of the esophageal wall. The etiology is unknown, but the pathologic findings include dilatation of excretory ducts of submucosal glands. The predominant symptom is dysphagia, and esophageal stricture occurs frequently. Diseases such as diabetes mellitus, esophageal candidiasis, gastroesophageal reflux disease, and chronic alcoholism are often combined. Since most EIP cases are benign, the mainstream treatment is symptom relief by endoscopic dilatation or medical treatment of accompanied diseases. This report describes the case of a 68-year-old male patient who suffered from chest tightness for 2 months and was diagnosed with EIP. This symptom disappeared after 2 months of medical treatment, and the patient is now being regularly followed up. PMID:21461080

Chon, Young Eun; Hwang, Sena; Jung, Kyu Sik; Lee, Hyun Jung; Lee, Sang Gil; Shin, Sung Kwan

2011-01-01

211

Management of refractory and complicated reflux esophagitis.  

PubMed Central

Simple intermittent heartburn with minor or no esophagitis can be treated with simple measures including lifestyle changes and antacids as needed, or H2 receptor antagonists (H2RA), and has a good outcome. Problematic reflux includes resistance to therapy, stricture, Barrett's esophagus and aspiration. Severe reflux esophagitis, often resistant to H2RA therapy, requires more potent treatment with potent acid suppression using proton pump inhibitors, often indefinitely. When complicated by stricture, dilatations with potent acid suppression are needed. Barrett's esophagus is subject to esophagitis, which is no more difficult to treat than other cases of esophagitis. Reflux in Barrett's esophagus should be treated on its own merits without regard to the presence of Barrett's epithelium. Dysplasia leading to adenocarcinoma is a different problem, apparently not influenced by reduced exposure to acid. Indications for antireflux surgery are quite limited and should be carefully analyzed as a cost/risk/benefit problem. PMID:9165696

Hirschowitz, B. I.

1996-01-01

212

Resection for Esophageal Cancer in the Elderly  

PubMed Central

This article will focus on the impact of patient age on outcomes following esophageal resection as well as potential strategies to improve perioperative management of geriatric patients undergoing esophagectomy for cancer. PMID:20066945

Chang, Andrew C.; Lee, Julia S.

2009-01-01

213

Esophageal manometry in 95 healthy adult volunteers  

Microsoft Academic Search

Although esophageal manometry is widely used in clinical practice, the normal range of esophageal contraction parameters is poorly defined. Therefore, 95 healthy volunteers (mean age: 43 years; range 22–79 years) were studied with a low-compliance infusion system and 4.5-mm-diameter catheter. All subjects were given 10 wet swallows (5 cc H2O) and 38 subjects also were given 10 dry swallows. Results:

Joel E. Richter; Wallace C. Wu; Doree N. Johns; John N. Blackwell; Joseph L. Nelson; June A. Castell; Donald O. Castell

1987-01-01

214

Role of diagnostic tests in esophageal evaluation  

SciTech Connect

In the evaluation of esophageal disease, the appropriate question must be asked before the correct tests can be selected. Reflux can be demonstrated by radiologic methods, pH testing or radioisotopic techniques. Esophageal mucosal damage is best evaluated by x-ray, endoscopy, or biopsy. Chest pain is demonstrated by acid infusion or by manometry. Two algorithms are presented for the evaluation of chest pain and reflux symptoms.

Silverstein, B.D.; Pope, C.E. II

1980-06-01

215

Surgical treatment of esophageal carcinoma with curative intent: analysis of a single center experience  

PubMed Central

Background We retrospectively reviewed our series of 76 patients who underwent esophagectomy, with curative intent, for esophageal carcinoma over the last 10 years. Method The mean age was 60 years ranging between 46 to 76 years. Fifty-seven patients had a squamous cell carcinoma and 19 patients had an adenocarcinoma. In 15 cases induction therapy was accomplished prior to surgery. A narrow gastric tube was used to restore continuity in 74 patients (97.3%). Medical records were reviewed and data analysis was performed. Results Peri-operative mortality was 2.6%. Overall survival at 1, 3 and 5 years was 85,5%, 67,7% and 52,7%, respectively, with no significant difference between the squamous cell disease group and the adenocarcinoma group. Although T factor and stage at the time of surgery influenced overall survival, the presence of nodal metastasis had the major impact on survival as confirmed by univariate and multivariate analysis with a 5 year survival rate of 32% regardless of the use or not of adjuvant chemo-radiotherapy and the pathologic stage. Conclusions Esophagectomy still represents a valid treatment for esophageal carcinoma in well selected patients. Both pT stage and N stage appear to be the most important factors determining survival for patients with completely resected esophageal carcinoma. PMID:23509872

2013-01-01

216

Clinical features, outcomes and treatment-related pneumonitis in elderly patients with esophageal carcinoma  

PubMed Central

AIM: To investigate the clinical features and prognoses of elderly patients with esophageal carcinoma and to compare the effects of radiotherapy and rates of treatment-related pneumonitis (TRP) between elderly and non-elderly patients. METHODS: A total of 236 patients with esophageal carcinoma who received radiotherapy between 2002 and 2012 were enrolled. The patients were divided into two groups: an elderly group (age ? 65 years) and a non-elderly group (age < 65 years). The tumor position and stage, lymph node and distant metastases, and incidence and severity of TRP were compared. Multivariate analysis was applied to identify independent prognostic factors. RESULTS: The median overall survival times after radiotherapy in the elderly and non-elderly groups were 18.5 and 20.5 mo, respectively. Cox regression analysis showed that TRP grade and tumor-node-metastasis (TNM) stage were independent prognostic factors in the elderly group. High-dose radiotherapy (> 60 Gy) was associated with a high incidence of TRP. Tumor TNM staging was significantly different between the two groups in which TRP occurred. Multivariate analysis showed that TNM stage was an independent prognostic factor. Esophageal carcinoma in elderly patients was relatively less malignant compared with that in non-elderly patients. CONCLUSION: An appropriate dose should be used to decrease the incidence of TRP in radiotherapy, and intensity modulated radiation therapy should be selected if possible. PMID:25278715

He, Jian; Zeng, Zhao-Chong; Shi, Shi-Ming; Yang, Ping

2014-01-01

217

Dicobalt II-II, II-III, and III-III complexes as spectroscopic models for dicobalt enzyme active sites.  

PubMed

A matched set of dinuclear cobalt complexes with II-II, II-III, and III-III oxidation states have been prepared and structurally characterized. In [(bpbp)Co2(O2P(OPh)2)2]n+ ( n = 1, 2, or 3; bpbp(-) = 2,6-bis(( N,N'-bis-(2-picolyl)amino)-methyl)-4-tertbutylphenolato), the nonbonded Co...Co separations are within the range 3.5906(17) to 3.7081(11) angstroms, and the metal ions are triply bridged by the phenolate oxygen atom of the heptadentate dinucleating ligand and by two diphenylphosphate groups. The overall structures and geometries of the complexes are very similar, with minor variations in metal-ligand bond distances consistent with oxidation state assignments. The CoIICoIII compound is a valence-trapped Robin-Day class II complex. Solid state 31P NMR spectra of the diamagnetic CoIIICoIII (3) and paramagnetic CoIICoIII (2) and CoIICoII (1) complexes show that 31P isotropic shifts broaden and move downfield by about 3000 ppm for each increment in oxidation state. Cyclic voltammetry corroborates the existence of the CoIICoII, CoIICoIII, and CoIIICoIII species in solution. The redox changes are not reversible in the applied scanning timescales, indicating that chemical changes are associated with oxidation and reduction of the cobalt centers. An investigation of the spectroscopic properties of this series has been carried out for its potential usefulness in analyses of the related spectroscopic properties of the dicobalt metallohydrolases. Principally, magnetic circular dichroism (MCD) has been used to determine the strength of the magnetic exchange coupling in the CoIICoII complex by analysis of the variable-temperature variable-field (VTVH) intensity behavior of the MCD signal. The series is ideal for the spectroscopic determination of magnetic coupling since it can occur only in the CoIICoII complex. The CoIICoIII complex contains a nearly isostructural CoII ion, but since CoIII is diamagnetic, the magnetic coupling is switched off, while the spectral features of the CoII ion remain. Analysis of the MCD data from the CoIICoIII complex has been undertaken in the theoretical context of a 4T1g ground-state of the CoII ion, initially in an octahedral ligand field that is split by both geometric distortion and zero-field splitting to form an isolated doublet ground state. The MCD data for the CoIICoII pair in the [(bpbp)Co2(O2P(OPh)2)2]+ complex were fitted to a model based on weak antiferromagnetic coupling with J = -1.6 cm (-1). The interpretation is confirmed by solid state magnetic susceptibility measurements. PMID:18494467

Johansson, Frank B; Bond, Andrew D; Nielsen, Ulla Gro; Moubaraki, Boujemaa; Murray, Keith S; Berry, Kevin J; Larrabee, James A; McKenzie, Christine J

2008-06-16

218

Esophagitis may not be a Major Precursor Lesion for Esophageal Squamous Cell Carcinoma in a High Incidence Area in North-Eastern Iran  

PubMed Central

BACKGROUND Esophageal squamous cell carcinoma (ESCC) is usually detected in advanced stages resulting in a very poor prognosis. Early diagnosis needs identification of clinically relevant precancerous lesions which could become the target of screening and early treatment. Our aim was to check whether esophagitis could serve as a relevant histological precursor of ESCC in Northern Iran. METHODS During 2001–2005, all adult patients who were referred to Atrak clinic for upper gastrointestinal endoscopy and biopsy were enrolled. Atrak clinic is a major center for upper gastrointestinal cancer research in eastern Golestan. All subjects had been complaining of upper GI symptoms and were under further investigation to rule out cancer. Biopsies from the endoscopically normal mid-esophagus and also just above the esophago-gastric junction were obtained in all subjects whose esophagus appeared normal during endoscopy and from endoscopically normal appearing mucosa at the proximal vicinity of any detected mass. Microscopic examinations for the verification of the presence or absence of esophagitis was performed by independant histological examination of the samples by two pathologists. All the discrepant diagnoses were resolved in joint diagnostic sessions. RESULTS During the study period 836 patients were enrolled including 419 non cancer patients (endoscopy clinic controls), 387 cancer patients, and 30 subjects with clinical diagnosis of malignancy referred for histological reconfirmation of diagnosis by repeated biopsy. Mild or marked mid-esophagitis was diagnosed in 39 (9.3%), 47 (12.5%) and 12 (40%) of endoscopy clinic controls, cancer patients and those who were suspicious for upper gastrointestinal malignancies. CONCLUSION Our observation does not show evidence for esophagitis to be a predisposing factor for ESCC in Gonbad region In North Eastern Iran. PMID:25197529

Abedi-Ardekani, B; Sotoudeh, M; Aghcheli, K; Semnani, S; Shakeri, R; Taghavi, N; Nasrollahzadeh, D; Fahimi, S; Islami, F; Marjani, H; Malekzadeh, R

2011-01-01

219

Epigenetic Biomarkers in Esophageal Cancer  

PubMed Central

The aberrant DNA methylation of tumor suppressor genes is well documented in esophageal cancer, including adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) as well as in Barrett's esophagus (BE), a pre-malignant condition that is associated with chronic acid reflux. BE is a well-recognized risk factor for the development of EAC, and consequently the standard of care is for individuals with BE to be placed in endoscopic surveillance programs aimed at detecting early histologic changes that associate with an increased risk of developing EAC. Yet because the absolute risk of EAC in individuals with BE is minimal, a clinical need in the management of BE is the identification of additional risk markers that will indicate individuals who are at a significant absolute risk of EAC so that they may be subjected to more intensive surveillance. The best currently available risk marker is the degree of dysplasia in endoscopic biopsies from the esophagus; however, this marker is suboptimal for a variety of reasons. To date, there are no molecular biomarkers that have been translated to widespread clinical practice. The search for biomarkers, including hypermethylated genes, for either the diagnosis of BE, EAC, or ESCC or for risk stratification for the development of EAC in those with BE is currently an area of active research. In this review, we summarize the status of identified candidate epigenetic biomarkers for BE, EAC, and ESCC. Most of these aberrantly methylated genes have been described in the context of early detection or diagnostic markers; others might prove useful for estimating prognosis or predicting response to treatment. Finally, special attention will be paid to some of the challenges that must be overcome in order to develop clinically useful esophageal cancer biomarkers. PMID:22406828

Kaz, Andrew M.; Grady, William M.

2012-01-01

220

Structural and magnetic characterization of mixed valence Co(II, III)xZn1-xO epitaxial thin films  

NASA Astrophysics Data System (ADS)

In this article, we report on the Co atom incorporation, secondary phase formation and composition-dependent magnetic and optical properties of mixed valence Co(II, III)xZn1-xO epitaxial thin films grown by pulsed laser deposition. The intended total Co concentration is varied between ~6-60 at.% with relatively higher concentration of +3 over +2 charge state. Mixed valence Co(II, III) shows high solubility in ZnO (up to 38 at.%) and ferromagnetism is observed in samples with total Co incorporation of ~29 and 38 at.%. Electron diffraction pattern and high resolution transmission electron microscopy images reveal single crystalline nature of the thin films with wurtzite structure. Co oxide interlayer, with both rock salt and spinel structure, are observed to be formed between the substrate and wurtzite film for total Co concentration at ~17 at.% and above. Magnetization shows composition dependence with a saturation moment value of ~93 emu cm-3 and a coercive field of ~285 Oe observed for ~38 at.% Co:ZnO films. Ferromagnetism was not observed for films with Co concentration 17 and 9 at.%. The Co oxide interlayer does not show any ferromagnetism. All the films are n-type with carrier concentration ~1019 cm-3. The observed magnetism is probably resulting from direct antiferromagntic exchange interaction between Co2+ and Co3+ ions favored by heavy Co alloying giving rise to ferrimagnetism in the system.

Negi, D. S.; Loukya, B.; Dileep, K.; Sahu, R.; Shetty, S.; Kumar, N.; Ghatak, J.; Pachauri, N.; Gupta, A.; Datta, R.

2014-03-01

221

Chronic xerostomia increases esophageal acid exposure and is associated with esophageal injury  

SciTech Connect

OBJECTIVES: To assess the effects of chronic xerostomia on parameters of gastroesophageal reflux and esophagitis. DESIGN: Observational study of a cohort of male patients with xerostomia and age-matched control subjects. SETTING: Tertiary-care Veterans Affairs Medical Center. SUBJECTS: Sixteen male patients with chronic xerostomia secondary to radiation for head and neck cancers or medications. Nineteen age-matched male control subjects with comparable alcohol and smoking histories. MEASUREMENTS AND MAIN RESULTS: Esophageal motility was similar in patients with xerostomia and controls. Clearance of acid from the esophagus and 24-hour intraesophageal pH were markedly abnormal in patients with xerostomia. Symptoms and signs of esophagitis were significantly more frequent in subjects with xerostomia. CONCLUSIONS: Chronic xerostomia may predispose to esophageal injury, at least in part, by decreasing the clearance of acid from the esophagus and altering 24-hour intraesophageal pH. Esophageal injury is a previously unreported complication of long-term salivary deficiency.

Korsten, M.A.; Rosman, A.S.; Fishbein, S.; Shlein, R.D.; Goldberg, H.E.; Biener, A. (Gastrointestinal Section, Veterans Affairs Medical Center, Bronx, New York (USA))

1991-06-01

222

Prognostic significance of differentially expressed miRNAs in esophageal cancer  

PubMed Central

Altered microRNA (miRNA) expression has been found to promote carcinogenesis, but little is known about the role of miRNAs in esophageal cancer. In this study, we selected 10 miRNAs and analyzed their expression in 10 esophageal cancer cell lines and 158 tissue specimens using Northern blotting and in situ hybridization, respectively. We found that Let-7g, miR-21, and miR-195p were expressed in all 10 cell lines, miR-9 and miR-20a were not expressed in any of the cell lines, and miR-16-2, miR-30e, miR-34a, miR-126, and miR-200a were expressed in some of the cell lines but not others. In addition, transient transfection of miR-34a inhibited c-Met and cyclin D1 expression and esophageal cancer cell proliferation, whereas miR-16-2 suppressed RAR-?2 expression and increased tumor cell proliferation. Furthermore, we found that miR-126 expression was associated with tumor cell de-differentiation and lymph node metastasis, miR-16-2 was associated with lymph node metastasis, and miR-195p was associated with higher pathologic disease stages in patients with esophageal adenocarcinoma. Kaplan-Meier analysis showed that miR-16-2 expression and miR-30e expression were associated with shorter overall and disease-free survival in all esophageal cancer patients. In addition, miR-16-2, miR-30e, and miR-200a expression were associated with shorter overall and disease-free survival in esophageal adenocarcinoma patients; however, miR-16-2, miR-30e, and miR-200a expression was not associated with overall or disease-free survival in squamous cell carcinoma patients. Our data indicate that further evaluation of miR-30e and miR-16-2 as prognostic biomarkers is warranted in patients with esophageal adenocarcinoma. In addition, the role of miR-34a in esophageal cancer also warrants further study. PMID:20309880

Hu, Yuxin; Correa, Arlene M.; Hoque, Ashraful; Guan, Baoxiang; Ye, Fei; Huang, Jie; Swisher, Stephen G.; Wu, Tsung Teh; Ajani, Jaffer A.; Xu, Xiao-chun

2010-01-01

223

Endoscopic Mucosal Resection in the Management of Esophageal Neoplasia: Current Status and Future Directions  

PubMed Central

Endoscopic mucosal resection has expanded the role of the gastroenterologist in the management of esophageal neoplasia from screening and diagnosis to staging and endoscopic treatment. Its rise to prominence is a reflection of the long identified need to obtain histological information regarding depth of invasion and neoplastic margins during therapy that previously could not be achieved with ablative techniques. The resultant improvement in diagnosis and staging has allowed for better selection of patients for endoscopic therapy who may be spared invasive surgery. The clinical indications, endoscopic techniques, outcomes and complications in the management of esophageal neoplasia are reviewed in this manuscript. Training requirements to achieve proficiency in EMR as well as potential quality measures to assess competence are also proposed in this review. PMID:20541628

Namasivayam, Vikneswaran; Wang, Kenneth K.; Prasad, Ganapathy A

2010-01-01

224

Clinical and dosimetric factors of radiation-induced esophageal injury: Radiation-induced esophageal toxicity  

PubMed Central

AIM: To analyze the clinical and dosimetric predictive factors for radiation-induced esophageal injury in patients with non-small-cell lung cancer (NSCLC) during three-dimensional conformal radiotherapy (3D-CRT). METHODS: We retrospectively analyzed 208 consecutive patients (146 men and 62 women) with NSCLC treated with 3D-CRT. The median age of the patients was 64 years (range 35-87 years). The clinical and treatment parameters including gender, age, performance status, sequential chemotherapy, concurrent chemotherapy, presence of carinal or subcarinal lymph nodes, pretreatment weight loss, mean dose to the entire esophagus, maximal point dose to the esophagus, and percentage of volume of esophagus receiving >55 Gy were studied. Clinical and dosimetric factors for radiation-induced acute and late grade 3-5 esophageal injury were analyzed according to Radiation Therapy Oncology Group (RTOG) criteria. RESULTS: Twenty-five (12%) of the two hundred and eight patients developed acute or late grade 3-5 esophageal injury. Among them, nine patients had both acute and late grade 3-5 esophageal injury, two died of late esophageal perforation. Concurrent chemotherapy and maximal point dose to the esophagus ?60 Gy were significantly associated with the risk of grade 3-5 esophageal injury. Fifty-four (26%) of the two hundred and eight patients received concurrent chemotherapy. Among them, 25 (46%) developed grade 3-5 esophageal injury (P = 0.0001<0.01). However, no grade 3-5 esophageal injury occurred in patients who received a maximal point dose to the esophagus <60 Gy (P = 0.0001<0.01). CONCLUSION: Concurrent chemotherapy and the maximal esophageal point dose ?60 Gy are significantly associated with the risk of grade 3-5 esophageal injury in patients with NSCLC treated with 3D-CRT. PMID:15849822

Qiao, Wen-Bo; Zhao, Yan-Hui; Zhao, Yan-Bin; Wang, Rui-Zhi

2005-01-01

225

21 CFR 868.1920 - Esophageal stethoscope with electrical conductors.  

Code of Federal Regulations, 2010 CFR

...Esophageal stethoscope with electrical conductors. 868.1920 Section 868.1920 Food and Drugs FOOD AND DRUG ADMINISTRATION...ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1920 Esophageal stethoscope with electrical...

2010-04-01

226

Concomitant herpetic and eosinophilic esophagitis--a causality dilemma.  

PubMed

Eosinophilic and herpetic esophagitis are listed as independent causes of dysphagia, especially in young adult males. However, herpetic esophagitis rarely affects immunocompetent individuals. We report the case of a young, not immunocompromised patient, admitted because of severe dysphagia secondary to herpes simplex virus esophagitis. After complete resolution, an endoscopic and histologic reevaluation established the diagnosis of eosinophilic esophagitis. The potential association between the two conditions is discussed. PMID:23082710

Monsanto, P; Almeida, N; Cipriano, M A; Gouveia, H; Sofia, C

2012-09-01

227

Broken Esophageal Stent Successfully Treated by Interventional Radiology Technique  

SciTech Connect

Esophageal stent fractures occur quite rarely. A 61-year-old male patient was previously treated for rupture of benign stenosis, occurring after dilatation, by implanting an esophageal stent. However, a year after implantation, the patient suffered from dysphagia caused by the broken esophageal stent. He was treated with the interventional radiology technique, whereby a second implantation of the esophageal stent was carried out quite successfully.

Zelenak, Kamil, E-mail: zelenak@mfn.s [University Hospital, Department of Radiology (Slovakia); Mistuna, Dusan; Lucan, Jaroslav [University Hospital, Department of Surgery (Slovakia); Polacek, Hubert [University Hospital, Department of Radiology (Slovakia)

2010-06-15

228

ERCC1 Expression in Non-Small Cell Lung and Esophageal Cancer  

PubMed Central

Objective: “Excision Repair Cross-Complementation Group 1” (ERCC1) enzyme is a vitally important basic protein required for DNA repair. Recent studies suggest that ERCC1 is involved in resistance to antracycline-based chemotherapy regimens. In this study, we aimed to analyze ERCC1 expression in lung and esophageal cancer patients. We also aimed to investigate the possible correlation between the ERCC1 expression levels and patient demographic information. Materials and Methods: Twenty esophageal and 20 non-small cell lung cancer (NSCLC) patients diagnosed between December 2009 and December 2010, via either endoscopic, bronchoscopic or tru-cut biopsy, were included in this study. The ERCC1 expression levels were analyzed by the reverse transcriptase-polymerase chain reaction (RTPCR) method in RNA samples extracted from pathological biopsy specimens. The patient demographic information was also recorded. Results: There was no significant correlation between the ERCC1 expression level and demographic parameters, including the tumor, node, metastatis (TNM) staging, World Health Organization (WHO) grading, age, gender, hemoglobin level and albumin level, in the patient groups. The mean ERCC1 expression levels in the NSCLC and esophageal cancer patients were 0.71±0.85 and 0.62±0.78, respectively. The ERCC1 expression level was elevated in 15% of each patient group. Conclusion: Analysis of the ERCC1 expression in NSCLC and esophageal cancer patients prior to chemotherapy would be useful for personalized chemotherapy regimens and would provide more accurate prognostic information for the patient. PMID:25610304

Bilen, Nurhan; Tekin, Salim B; Topdagi, Omer

2014-01-01

229

Esophageal intramural pseudodiverticulosis characterized by barium esophagography: a case report  

Microsoft Academic Search

INTRODUCTION: Esophageal intramural pseudodiverticulosis is a rare condition characterized by the dilatation of the submucosal glands. CASE PRESENTATION: We present a case of esophageal intramural pseudodiverticulosis in a 72-year-old Caucasian man who presented with dysphagia and with a background history of alcohol abuse. An upper gastrointestinal endoscopy of our patient showed an esophageal stricture with abnormal mucosal appearances, but no

Owen J O'Connor; Adrian Brady; Fergus Shanahan; Eamonn Quigley; Michael O'Riordain; Michael M Maher

2010-01-01

230

Case Report Alendronate-induced Esophagitis in an Elderly Woman  

Microsoft Academic Search

Ingestion of alendronate sodium (Fosamax) had been reported to sometimes cause erosive or ulcerative esophagitis. Despite its widespread use and several case reports describing the clinical and endoscopic presentation, there has been limited discussion on the histologic appearances of the esophagitis caused by the medication. Here we describe one case of an elderly woman who presented with alendronate-induced esophagitis. The

Victoria Gómez; Shu-Yuan Xiao

231

Esophageal cancer as second primary tumor after breast cancer radiotherapy  

Microsoft Academic Search

Background: An increased risk of esophageal cancer has been reported in survivors of breast cancer treated with radiotherapy. This study further characterizes this association.Methods: Through hospital databases, 118 patients (109 men, 9 women) treated for esophageal cancer between 1985 and 1993 were identified, of whom 37 had 60 synchronous or metachronous cancers. 5 women had primary esophageal cancer after having

Beatrix Scholl; Ernane D Reis; Abderrahim Zouhair; Igor Chereshnev; Jean-Claude Givel; Michel Gillet

2001-01-01

232

Duodenogastroesophageal reflux and esophageal mucosal injury in mechanically ventilated patients  

Microsoft Academic Search

Background & Aims: Esophagitis has been reported to be the most frequent cause of upper gastrointestinal bleeding in intensive care patients. The mechanisms causing esophagitis are unclear. The aim of this study was to measure esophageal acid and bile reflux and to examine the relationship between reflux and mucosal injury in mechanically ventilated patients. Methods: Twenty-five critically ill, mechanically ventilated

Alexander Wilmer; Jan Tack; Eric Frans; Hilde Dits; Steven Vanderschueren; Anemie Gevers; Hesmann Bobbaers

1999-01-01

233

Molecular and cellular features of esophageal cancer cells  

Microsoft Academic Search

More than 70 cell lines were established from esophageal cancer, including 15 TE-series cell lines established by the authors. This article reviews molecular and cellular features of esophageal cancer cells from studies using these cell lines as well as primary tumors. The subjects reviewed include primary cultures of normal epithelium of the esophagus and of esophageal tumors, their growth and

Tetsuro Nishihira; Yu Hashimoto; Masafumi Katayama; Shozo Mori; Toshio Kuroki

1993-01-01

234

Impact of esophageal bile exposure on the genesis of reflux esophagitis in the absence of gastric acid after total gastrectomy  

Microsoft Academic Search

OBJECTIVE:The role of duodenal contents refluxing into the esophagus in producing reflux esophagitis (RE) remains unclear. We aimed to assess the impact of esophageal bile exposure on the genesis of RE in reference to esophageal pH changes in the absence of gastric acid after total gastrectomy.METHODS:Thirty patients having undergone total gastrectomy were studied with concurrent 24-h esophageal pH and bilimetric

Takeyoshi Yumiba; Hisayoshi Kawahara; Kazuhiro Nishikawa; Yoshifumi Inoue; Toshinori Ito; Hikaru Matsuda

2002-01-01

235

Management of esophageal stricture after complete circular endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma  

PubMed Central

Background Endoscopic submucosal dissection (ESD) permits removal of esophageal epithelial neoplasms en bloc, but is associated with esophageal stenosis, particularly when ESD involves the entire circumference of the esophageal lumen. We examined the effectiveness of systemic steroid administration for control of postprocedural esophageal stricture after complete circular ESD. Methods Seven patients who underwent wholly circumferential ESD for superficially extended esophageal squamous cell carcinoma were enrolled in this study. In 3 patients, prophylactic endoscopic balloon dilatation (EBD) was started on the third post-ESD day and was performed twice a week for 8 weeks. In 4 patients, oral prednisolone was started with 30 mg daily on the third post-ESD day, tapered gradually (daily 30, 30, 25, 25, 20, 15, 10, 5 mg for 7 days each), and then discontinued at 8 weeks. EBD was used as needed whenever patients complained of dysphagia. Results En bloc ESD with tumor-free margins was safely achieved in all cases. Patients in the prophylactic EBD group required a mean of 32.7 EBD sessions; the postprocedural stricture was dilated up to 18 mm in diameter in these patients. On the other hand, systemic steroid administration substantially reduced or eliminated the need for EBD. Corticosteroid therapy was not associated with any adverse events. Post-ESD esophageal stricture after complete circular ESD was persistent, requiring multiple EBD sessions. Conclusions Use of oral prednisolone administration may be an effective treatment strategy for reducing post-ESD esophageal stricture after complete circular ESD. PMID:21542926

2011-01-01

236

Esophageal parakeratosis mimicking endoscopic appearance of superficial esophageal neoplastic lesion such as dysplasia.  

PubMed

The endoscopic findings of esophageal parakeratosis have not been well defined and its clinical significance including malignant potential is unclear. Here, we report a case of esophageal parakeratosis presenting as a discrete flat elevated lesion and mimicking the endoscopic appearance of superficial esophageal neoplastic lesion such as dysplasia or cancer. A 72-year-old woman was referred to our hospital for an esophageal lesion detected by upper endoscopy during a medical check-up. Upper endoscopy revealed a 5-cm sized whitish flat elevated lesion involving the mucosa of the middle esophagus. The surface of this lesion showed mild nodularity and the margin was discrete. When spraying with lugol solution, the lesion was not stained. On microscopic examination, esophageal parakeratosis was noted on the luminal surface with a hyaline eosinophilic cytoplasm and small elongate nuclei oriented parallel to the surface. Although pathological examination of initial biopsy specimens revealed no evidence of neoplasia or infection, we carried out follow-up upper endoscopies 1 month and 1 year later because of endoscopic findings mimicking dysplasia or cancer. Endoscopic and histopathological findings from the first and the second follow-up upper endoscopies were same as those of the first examination and the final diagnosis of esophageal parakeratosis was made. Given the present case, esophageal parakeratosis needs to be considered as a differential diagnosis when a flat elevated lesion is found in the esophagus and biopsy specimens reveal no evidence of dysplasia or cancer. PMID:22348836

Park, Jun Young; Kim, Da-Min; Min, Byung-Hoon; Kim, Kyoung-Mee

2012-03-01

237

A novel laparoscopic approach for severe esophageal stenosis due to reflux esophagitis: how to do it.  

PubMed

We herein report our technique for laparoscopic esophageal myotomy combined with Collis gastroplasty and Nissen fundoplication for severe esophageal stenosis. Our patient had experienced vomiting since childhood, and his dysphagia had gradually worsened. He was referred to our department for surgery because of resistance to pneumatic dilation. He was diagnosed with a short esophagus based on the findings of a preoperative upper gastrointestinal series and GI endoscopy. After exposing the abdominal esophagus, esophageal myotomy around the esophago-gastric junction (EGJ) was undertaken to introduce an esophageal bougie into the stomach. Then, stapled wedge gastroplasty was performed, and a short and loose Nissen fundoplication was performed. In addition, the bulging mucosa after myotomy was patched using the Dor method. The patient's postoperative course was uneventful. Most patients with esophageal stricture require subtotal esophagectomy. Laparoscopic surgery for patients with benign esophageal stricture refractory to repeated pneumatic dilation is challenging. However, our current procedure might abrogate the need for invasive esophagectomy for the surgical management of severe esophageal stenosis. PMID:24647633

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se Ryung; Akimoto, Shunsuke; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2015-02-01

238

Thoracoscopic approach for congenital esophageal stenosis.  

PubMed

Congenital esophageal stenosis (CES) is an infrequent entity; however, many cases have been reported during the last years. Its incidence falls between 1 per 25,000 and 1 per 50,000 live births and is associated with other congenital malformations in 17% to 33% of cases (mainly esophageal atresia). Congenital esophageal stenosis is defined as an intrinsic alteration of the esophageal wall given by the presence of ectopic tracheobronchial tissue, membranous diaphragm, muscular hypertrophy, or diffuse fibrosis of the submucosa, among other causes. The therapeutic options include endoscopic dilation and resection plus anastomosis (by either laparotomy or thoracotomy, depending on the level of the stenosis). We present the case of a 1-month-old baby boy with a CES located in the distal esophagus that is associated with anophthalmia and micropenis. We treated the lesion by means of a thoracoscopic resection of the affected segment and an esophageal end-to-end anastomosis. The patient's long-term outcome was uneventful. As far as we know, this is the first report on thoracoscopic resolution of a CES. PMID:17011258

Martinez-Ferro, Marcelo; Rubio, Martin; Piaggio, Lisandro; Laje, Pablo

2006-10-01

239

Sequential extraction method for determination of Fe(II/III) and U(IV/VI) in suspensions of iron-bearing phyllosilicates and uranium.  

PubMed

Iron-bearing phyllosilicates strongly influence the redox state and mobility of uranium because of their limited hydraulic conductivity, high specific surface area, and redox reactivity. Standard extraction procedures cannot be accurately applied for the determination of clay-Fe(II/III) and U(IV/VI) in clay mineral-U suspensions such that advanced spectroscopic techniques are required. Instead, we developed and validated a sequential extraction method for determination of clay-Fe(II/III) and U(IV/VI) in clay-U suspensions. In our so-called "H(3)PO(4)-HF-H(2)SO(4) sequential extraction" method, H(3)PO(4)-H(2)SO(4) is used first to solubilize and remove U, and the remaining clay pellet is subject to HF-H(2)SO(4) digestion. Physical separation of U and clay eliminates valence cycling between U(IV/VI) and clay-Fe(II/III) that otherwise occurred in the extraction solutions and caused analytical discrepancies. We further developed an "automated anoxic KPA" method to measure soluble U(VI) and total U (calculate U(IV) by difference) and modified the conventional HF-H(2)SO(4) digestion method to eliminate a series of time-consuming weighing steps. We measured the kinetics of uraninite oxidation by nontronite using this sequential extraction method and anoxic KPA method and measured a stoichiometric ratio of 2.19 ± 0.05 mol clay-Fe(II) produced per mol U(VI) produced (theoretical value of 2.0). We found that we were able to recover 98.0-98.5% of the clay Fe and 98.1-98.5% of the U through the sequential extractions. Compared to the theoretical stoichiometric ratio of 2.0, the parallel extractions of 0.5 M HCl for clay-Fe(II) and 1 M NaHCO(3) for U(VI) leached two-times more Fe(II) than U(VI). The parallel extractions of HF-H(2)SO(4) for clay Fe(II) and 1 M NaHCO(3) for U(VI) leached six-times more Fe(II) than U(VI). PMID:23075386

Luan, Fubo; Burgos, William D

2012-11-01

240

Nanoscale markers of esophageal field carcinogenesis: potential implications for esophageal cancer screening  

PubMed Central

Background and study aims Esophageal adenocarcinoma (EAC) has a dismal prognosis unless treated early or prevented at the precursor stage of Barrett’s esophagus-associated dysplasia. However, some patients with cancer or dysplastic Barrett’s esophagus (DBE) may not be captured by current screening and surveillance programs. Additional screening techniques are needed to determine who would benefit from endoscopic screening or surveillance. Partial wave spectroscopy (PWS) microscopy (also known as nanocytology) measures the disorder strength (Ld), a statistic that characterizes the spatial distribution of the intracellular mass at the nanoscale level and thus provides insights into the cell nanoscale architecture beyond that which is revealed by conventional microscopy. The aim of the present study was to compare the disorder strength measured by PWS in normal squamous epithelium in the proximal esophagus to determine whether nanoscale architectural differences are detectable in the field area of EAC and Barrett’s esophagus. Methods During endoscopy, proximal esophageal squamous cells were obtained by brushings and were fixed in alcohol and stained with standard hematoxylin and Cyto-Stain. The disorder strength of these sampled squamous cells was determined by PWS. Results A total of 75 patient samples were analyzed, 15 of which were pathologically confirmed as EAC, 13 were DBE, and 15 were non-dysplastic Barrett’s esophagus; 32 of the patients, most of whom had reflux symptoms, acted as controls. The mean disorder strength per patient in cytologically normal squamous cells in the proximal esophagus of patients with EAC was 1.79-times higher than that of controls (P<0.01). Patients with DBE also had a disorder strength 1.63-times higher than controls (P<0.01). Conclusion Intracellular nanoarchitectural changes were found in the proximal squamous epithelium in patients harboring distal EAC and DBE using PWS. Advances in this technology and the biological phenomenon of the field effect of carcinogenesis revealed in this study may lead to a useful tool in non-invasive screening practices in DBE and EAC. PMID:24019132

Konda, Vani JA; Cherkezyan, Lusik; Subramanian, Hariharan; Wroblewski, Kirsten; Damania, Dhwanil; Becker, Valentin; Gonzalez, Mariano Haba Ruiz; Koons, Ann; Goldberg, Michael; Ferguson, Mark K; Waxman, Irving; Roy, Hermant K; Backman, Vadim

2014-01-01

241

A time-dependent study of passive esophageal wall properties and collagen content in rabbits with esophageal varices  

Microsoft Academic Search

The passive biomechanical wall properties of the esophagus were studied in rabbits with esophageal varices and controls using a four-electrode impedance technique. Stepwise pressure inflation and deflation was done for analysis of esophageal cross-sectional area, compliance, and hysteresis monthly during six months. At sacrifice, the esophageal collagen content was determined. A small but statistically insignificant increase in compliance was observed

H. Gregersen; L. Knudsen; B. Eika; L. Salling Nerstrøm; L. Rasmussen; L. S. Jensen

1991-01-01

242

2011 update on esophageal achalasia  

PubMed Central

There have been some breakthroughs in the diagnosis and treatment of esophageal achalasia in the past few years. First, the introduction of high-resolution manometry with pressure topography plotting as a new diagnostic tool has made it possible to classify achalasia into three subtypes. The most favorable outcome is predicted for patients receiving treatment for type II achalasia (achalasia with compression). Patients with typeI(classic achalasia) and type III achalasia (spastic achalasia) experience a less favorable outcome. Second, the first multicenter randomized controlled trial published by the European Achalasia Trial group reported 2-year follow-up results indicating that laparoscopic Heller myotomy was not superior to endoscopic pneumatic dilation (PD). Although the follow-up period was not long enough to reach a convincing conclusion, it merits the continued use of PD as a generally available technique in gastroenterology. Third, the novel endoscopic technique peroral endoscopic myotomy is a promising option for treating achalasia, but it requires increased experience and cautious evaluation. Despite all this good news, the bottom line is a real breakthrough from the basic studies to identify the actual cause of achalasia that may impede treatment success is still anticipated. PMID:22529685

Chuah, Seng-Kee; Hsu, Pin-I; Wu, Keng-Liang; Wu, Deng-Chyang; Tai, Wei-Chen; Changchien, Chi-Sin

2012-01-01

243

Repetitive sequences, genomic instability and Barrett's esophageal adenocarcinoma  

PubMed Central

Barrett's esophageal adenocarcinoma (BAC) is a cancer associated with heartburn. If gastroesophageal reflux is not treated, the exposure to acid over the years, leads to a premalignant condition known as Barrett's esophagus (BE) which then progresses through low grade and high grade dysplasias to Barrett's adenocarcinoma. Genomic instability, which seems to arise early at BE stage, leads to accrual of mutational changes which underlie the the succession of histological and physiological changes associated with this disease. Genomic instability is therefore an important target for prevention and treatment of cancer and it is important to elucidate the mechanisms associated with this problem. We have shown that elevated/deregulated homologous recombination mediates genomic instability in cancer. Recently we also demonstrated that the mutational rates of individual chromosomes in BAC cells correlate with their ALU frequency. The aims of this article are to briefly discuss different types of repetitive sequences and highlight their importance in physiology of normal and cancer cells, especially BAC. PMID:22479688

2011-01-01

244

Aortoesophageal fistula due to esophageal ulcer.  

PubMed

Aortoesophageal fistula is a rare but fatal disease. Many such fistulas are caused by an aortic aneurysm, a previous operation, or esophageal disease. We report a case of aortoesophageal fistula due to an esophageal ulcer. A 66-year-old man suffered massive hematemesis; he was diagnosed as having an aortoesophageal fistula due to an esophageal ulcer after examination by upper endoscopy, computed tomography, and angiography. He had no aortic aneurysm, nor was there a history of a previous operation. An emergency operation was performed, but we could only accomplish closure because clamping of the aorta was impossible, and the source of the bleeding could not be established. He died 4 days later after sudden hemorrhage. Surgical outcome depends on early surgical intervention before massive hemorrhage occurs. PMID:19440823

Takano, Shinji; Katsuhara, Kazuhiro; Nobuhara, Kenji; Ueda, Shigeharu; Imura, Masato; Hohjo, Yoshihisa

2009-05-01

245

Advances in clinical management of eosinophilic esophagitis.  

PubMed

Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated clinicopathologic condition that has become an increasingly important cause of upper gastrointestinal morbidity in adults and children over the past 2 decades. It is diagnosed based on symptoms of esophageal dysfunction, the presence of at least 15 eosinophils/high-power field in esophageal biopsy specimens, and exclusion of competing causes of esophageal eosinophilia, including proton pump inhibitor-responsive esophageal eosinophilia. We review what we have recently learned about the clinical aspects of EoE, discussing the clinical, endoscopic, and histological features of EoE in adults and children. We explain the current diagnostic criteria and challenges to diagnosis, including the role of gastroesophageal reflux disease and proton pump inhibitor-responsive esophageal eosinophilia. It is also important to consider the epidemiology of EoE (with a current incidence of 1 new case per 10,000 per year and prevalence of 0.5 to 1 case per 1000 per year) and disease progression. We review the main treatment approaches and new treatment options; EoE can be treated with topical corticosteroids, such as fluticasone and budesonide, or dietary strategies, such as amino acid-based formulas, allergy test-directed elimination diets, and nondirected empiric elimination diets. Endoscopic dilation has also become an important tool for treatment of fibrostenotic complications of EoE. There are a number of unresolved issues in EoE, including phenotypes, optimal treatment end points, the role of maintenance therapy, and treatment of refractory EoE. The care of patients with EoE and the study of the disease span many disciplines; EoE is ideally managed by a multidisciplinary team of gastroenterologists, allergists, pathologists, and dieticians. PMID:25109885

Dellon, Evan S; Liacouras, Chris A

2014-12-01

246

Activation of type-1 cannabinoid receptor shifts the balance between excitation and inhibition towards excitation in layer II/III pyramidal neurons of the rat prelimbic cortex.  

PubMed

Activation of the endocannabinoid (eCB) system by exogenous cannabinoids (drug abuse) can alter the physiology of the brain circuits involved in higher-order cognitive functions such as the medial prefrontal cortex (mPFC). A proper balance between excitation and inhibition (E/I balance) is critical for neuronal network oscillations underlying cognitive functions. Since type-1 cannabinoid receptors (CB1Rs), expressed in many brain areas including the mPFC, can modulate excitatory and inhibitory neurotransmission, we aimed to determine whether CB1R activation results in modifications of the E/I balance. We first confirm the presence of functional presynaptic CB1Rs that can modulate both excitatory and inhibitory inputs to layer II/III pyramidal neurons of the prelimbic (PL) area of the mPFC. By decomposing the synaptic response evoked by layer I stimulation into its excitatory and inhibitory components, we show that in vitro CB1R activation with the cannabinoid receptor agonists WIN55,212-2 (WIN) and CP-55940 (CP) modulates the balance between excitation and inhibition (E/I balance) of layer II/III pyramidal neurons. This treatment caused a significant shift of the E/I balance towards excitation, from 18/82 % to 25/75 % (WIN) and from 17/83 to 30/70 % (CP). Finally, when animals were injected with a cannabinoid receptor agonist, we observed a shift of the E/I balance (measured in vitro) towards excitation 1 h after WIN (24/76 %) or after CP injection (30/70 %) when compared to vehicle-injected animals (18/82 %). This modulation of the E/I balance by CB1Rs may thus be fundamental in the regulation of local PL cortical network excitability and could be the mechanism through which excessive CB1R activation (cannabis abuse) affects cognitive functions. PMID:25081244

den Boon, Femke S; Werkman, Taco R; Schaafsma-Zhao, Qiluan; Houthuijs, Kas; Vitalis, Tania; Kruse, Chris G; Wadman, Wytse J; Chameau, Pascal

2014-08-01

247

Drug-induced esophageal injury with an occult vascular ring.  

PubMed

Drug-induced esophageal injury is an under-recognized clinical problem, and is associated with antibiotic use in more than 50% of cases. The current report describes a teenage girl who presented with symptoms of pill-induced esophagitis following doxycycline use. Subsequent investigations identified a previously undiagnosed vascular ring. Although most patients who experience drug-induced esophageal injury have no underlying anatomical or functional disorder of the esophagus, the condition is more common in areas of esophageal narrowing. The present case illustrates the possibility of an occult esophageal obstruction representing a risk factor for pill esophagitis. The etiologies, mechanisms and management of drug-induced esophageal injury are reviewed, and aspects of vascular rings that are relevant to paediatricians are discussed. PMID:23115494

Guttman, Orlee R; Zachos, Mary

2011-11-01

248

Drug-induced esophageal injury with an occult vascular ring  

PubMed Central

Drug-induced esophageal injury is an under-recognized clinical problem, and is associated with antibiotic use in more than 50% of cases. The current report describes a teenage girl who presented with symptoms of pill-induced esophagitis following doxycycline use. Subsequent investigations identified a previously undiagnosed vascular ring. Although most patients who experience drug-induced esophageal injury have no underlying anatomical or functional disorder of the esophagus, the condition is more common in areas of esophageal narrowing. The present case illustrates the possibility of an occult esophageal obstruction representing a risk factor for pill esophagitis. The etiologies, mechanisms and management of drug-induced esophageal injury are reviewed, and aspects of vascular rings that are relevant to paediatricians are discussed. PMID:23115494

Guttman, Orlee R; Zachos, Mary

2011-01-01

249

MicroRNAs and esophageal cancer  

PubMed Central

Cancer of the esophagus is a highly aggressive disease associated with an overall poor prognosis. There is an insistent need for improving our understanding of the molecular basis of this disease. The recent emergence of observations on the role of microRNAs in cancer and their potential as biomarkers has prompted many investigations to examine their relevance to esophageal cancer. This article provides an introduction to microRNA biology and the techniques involved in studying them, and summates what is now known about their role and utility in regard to neoplastic esophageal diseases. PMID:22811805

Patnaik, Santosh Kumar; Mallick, Reema

2010-01-01

250

Influence of Ionizing Radiation on Stromal-Epithelial Communication in Esophageal Carcinogenesis  

NASA Astrophysics Data System (ADS)

Esophageal cancer is the 6th leading cause of cancer death worldwide and is associated with a variety of risk factors including tobacco use, heavy alcohol consumption, human papilloma virus infection, and certain dietary factors such as trace mineral and vitamin deficiencies. A connection with ionizing radiation exposure is revealed by the high excess relative risk for esophageal squamous cell carcinoma observed in the survivors of the atomic bomb detonations in Japan. Esophageal carcinomas are also seen as secondary malignancies in patients who received radiotherapy for breast and thoracic cancers; additionally, patients with head/neck and oral squamous cell cancers are at increased risk for metachronous esophageal squamous cell cancers. This malignancy is rapidly fatal, mainly because it remains asymptomatic until late, advanced stages when the disease is rarely responsive to treatment. In normal epithelium, the stromal microenvironment is essential for the maintenance and modulation of cell growth and differentiation. Cross talk between the epithelial and stromal compartments can influence many aspects of malignant progression, including tumor cell proliferation, migration, invasion and recruitment of new blood vessels. To test the hypothesis that radiation exposure plays a role in esophageal carcinogenesis via non-targeted mechanisms involving stromal-epithelial cell communication, we are studying radiation effects on hTERT-immortalized human esophageal epithelial cells and genetic variants grown in co-culture with human esophageal stromal fibrob-lasts (Okawa et al., Genes Dev. 2007. 21: 2788-2803). We examined how irradiation of stromal fibroblasts affected epithelial migration and invasion, behaviors associated with cancer promotion and progression. These assays were conducted in modified Boyden chambers using conditioned media from irradiated fibroblasts. Our results using low LET gamma radiation showed a dose-dependent increase in migration of epithelial cells when exposed to conditioned media from irradiated vs. non-irradiated fibroblasts. We also observed enhanced invasion through a basement membrane matrix in similarly treated cells. Candidate factors that me-diate these effects were identified using antibody capture arrays, and their increased secretion in irradiated fibroblasts was confirmed using ELISAs. We are currently analyzing the effect of these individual factors on epithelial migration and invasion, as well as their influence on cell survival and DNA repair. Our current studies using high-LET radiation will elucidate radiation quality effects on these processes. These results should further our understanding of the mechanisms by which radiation impacts the tissue microenvironment and how it influences cancer development processes.

Huff, Janice; Patel, Zarana; Grugan, Katharine; Rustgi, Anil; Cucinotta, Francis A.

251

A case of metachronous development of esophageal squamous cell carcinoma in the patient with esophageal carcinosarcoma.  

PubMed

Esophageal carcinosarcoma is a rare malignant esophageal neoplasm consisting of both carcinomatous and sarcomatous elements, with an incidence of 0.5%. There have been only a few case reports of carcinosarcoma and squamous cell carcinoma coexisting in the esophagus. However, all of these are cases of synchronous or metachronous development of carcinosarcoma after chemoradiotherapy in patients of esophageal squamous cell carcinoma. A 53-year-old man underwent esophagogas-troduodenoscopy because of chest pain for several months. Endoscopic examination revealed a huge pedunculated esophageal polypoid mass. Endoscopic submucosal dissection (ESD) was performed and histopathologic examination confirmed spindle cell carcinoma (carcinosarcoma). He refused additional esophagectomy. After 21 months, third follow-up endoscopy showed poorly-demarcated flat, faint discolored lesions at different location from the previous ESD site and endoscopic biopsies confirmed squamous cell carcinoma. To the best of our knowledge, this is the first case of metachronous development of esophageal squamous cell carcinoma in a patient with esophageal carcinosarcoma. (Korean J Gastroenterol 2014;64:364-369). PMID:25530588

Cha, Ra Ri; Jung, Woon Tae; Oh, Hye Won; Kim, Hee Jin; Ha, Chang Yoon; Kim, Hong Jun; Kim, Tae Hyo; Ko, Gyung Hyuck

2014-12-25

252

Rare complication of percutaneous endoscopic gastrostomy: Ostomy metastasis of esophageal carcinoma.  

PubMed

The authors present the case of a 55-year-old male with a stage III (T4N1M0) squamous-cell esophageal carcinoma, who underwent percutaneous endoscopic gastrostomy (PEG). The pull method of tube placement was used. Five months after the procedure, the patient was referred to the hospital with a hard palpable tumour at the ostomy site. The histologic exam revealed an abdominal wall metastasis of the esophageal cancer. The authors present this case because of the rarity of metastasis in ostomy after placement of PEG in patients with tumours located in the head and neck. In this particular context and judging by the rarity of situation, the clinical impact of this phenomenon is limited. Nevertheless, metastasis in ostomy site could be prevented by the push method, laparoscopy or laparotomy. PMID:24244807

Sousa, Ana Lúcia; Sousa, Diamantino; Velasco, Francisco; Açucena, Francisco; Lopes, Ana; Guerreiro, Horácio

2013-11-15

253

Acute esophageal necrosis caused by alcohol abuse  

PubMed Central

Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture. PMID:16222758

Endo, Tetsu; Sakamoto, Juichi; Sato, Ken; Takimoto, Miyako; Shimaya, Koji; Mikami, Tatsuya; Munakata, Akihiro; Shimoyama, Tadashi; Fukuda, Shinsaku

2005-01-01

254

Benign esophageal lesions: Endoscopic and pathologic features  

PubMed Central

Benign esophageal lesions have a wide spectrum of clinical and pathologic features. Understanding the endoscopic and pathologic features of esophageal lesions is essential for their detection, differential diagnosis, and management. The purpose of this review is to provide updated features that may help physicians to appropriately manage these esophageal lesions. The endoscopic features of 2997 patients are reviewed. In epithelial lesions, the frequency of occurrence was in the following order: glycogenic acanthosis, heterotopic gastric mucosa, squamous papilloma, hyperplastic polyp, ectopic sebaceous gland and xanthoma. In subepithelial lesions, the order was as follows: hemangioma, leiomyoma, dysphagia aortica and granular cell tumor. Most benign esophageal lesions can be diagnosed according to their endoscopic appearance and findings on routine biopsy, and submucosal lesions, by endoscopic resection. Management is generally based upon the confidence of diagnosis and whether the lesion causes symptoms. We suggest endoscopic resection of all granular cell tumors and squamous papillomas because, while rare, these lesions have malignant potential. Dysphagia aortica should be considered in the differential diagnosis of dysphagia in the elderly.

Tsai, Shu-Jung; Lin, Ching-Chung; Chang, Chen-Wang; Hung, Chien-Yuan; Shieh, Tze-Yu; Wang, Horng-Yuan; Shih, Shou-Chuan; Chen, Ming-Jen

2015-01-01

255

Postoperative Intensive Care Treatment after Esophageal Resection  

Microsoft Academic Search

The aim of this article is to give a short review of problems associated with the intensive care treatment of patients after esophageal resection. Pulmonary dysfunction, supraventricular tachyarrhythmia, anastomotic leakage and mental disorders are the topics covered. Systemic inflammatory reaction and sepsis is the linking topic between these specific complications. Pulmonary dysfunction having an incidence of up to 40% is

Dirk L. Stippel; K. Tobias E. Beckurts

2004-01-01

256

Hydraulically controlled magnetic bougienage for correction of long-gap esophageal atresia  

E-print Network

About one in 4000 babies in the United States is born with their esophageal disconnected and separated by a gap, which is called esophageal atresia. Esophageal atresia with a relatively short gap can be directly corrected ...

Noh, Minkyun

2014-01-01

257

Screening pre-bariatric surgery patients for esophageal disease with esophageal capsule endoscopy  

PubMed Central

AIM: To determine if esophageal capsule endoscopy (ECE) is an adequate diagnostic alternative to esophagogastroduodenoscopy (EGD) in pre-bariatric surgery patients. METHODS: We conducted a prospective pilot study to assess the diagnostic accuracy of ECE (PillCam ESO2, Given Imaging) vs conventional EGD in pre-bariatric surgery patients. Patients who were scheduled for bariatric surgery and referred for pre-operative EGD were prospectively enrolled. All patients underwent ECE followed by standard EGD. Two experienced gastroenterologists blinded to the patient’s history and the findings of the EGD reviewed the ECE and documented their findings. The gold standard was the findings on EGD. RESULTS: Ten patients with an average body mass index of 50 kg/m2 were enrolled and completed the study. ECE identified 11 of 14 (79%) positive esophageal/gastroesophageal junction (GEJ) findings and 14 of 17 (82%) combined esophageal and gastric findings identified on EGD. Fisher’s exact test was used to compare the findings and no significant difference was found between ECE and EGD (P = 0.64 for esophageal/GEJ and P = 0.66 for combined esophageal and gastric findings respectively). Of the positive esophageal/GEJ findings, ECE failed to identify the following: hiatal hernia in two patients, mild esophagitis in two patients, and mild Schatzki ring in two patients. ECE was able to identify the entire esophagus in 100%, gastric cardia in 0%, gastric body in 100%, gastric antrum in 70%, pylorus in 60%, and duodenum in 0%. CONCLUSION: There were no significant differences in the likelihood of identifying a positive finding using ECE compared with EGD in preoperative evaluation of bariatric patients. PMID:24115815

Shah, Ashish; Boettcher, Erica; Fahmy, Marianne; Savides, Thomas; Horgan, Santiago; Jacobsen, Garth R; Sandler, Bryan J; Sedrak, Michael; Kalmaz, Denise

2013-01-01

258

A Molecular Prognostic Model Predicts Esophageal Squamous Cell Carcinoma Prognosis  

PubMed Central

Background Esophageal squamous cell carcinoma (ESCC) has the highest mortality rates in China. The 5-year survival rate of ESCC remains dismal despite improvements in treatments such as surgical resection and adjuvant chemoradiation, and current clinical staging approaches are limited in their ability to effectively stratify patients for treatment options. The aim of the present study, therefore, was to develop an immunohistochemistry-based prognostic model to improve clinical risk assessment for patients with ESCC. Methods We developed a molecular prognostic model based on the combined expression of axis of epidermal growth factor receptor (EGFR), phosphorylated Specificity protein 1 (p-Sp1), and Fascin proteins. The presence of this prognostic model and associated clinical outcomes were analyzed for 130 formalin-fixed, paraffin-embedded esophageal curative resection specimens (generation dataset) and validated using an independent cohort of 185 specimens (validation dataset). Results The expression of these three genes at the protein level was used to build a molecular prognostic model that was highly predictive of ESCC survival in both generation and validation datasets (P?=?0.001). Regression analysis showed that this molecular prognostic model was strongly and independently predictive of overall survival (hazard ratio?=?2.358 [95% CI, 1.391–3.996], P?=?0.001 in generation dataset; hazard ratio?=?1.990 [95% CI, 1.256–3.154], P?=?0.003 in validation dataset). Furthermore, the predictive ability of these 3 biomarkers in combination was more robust than that of each individual biomarker. Conclusions This technically simple immunohistochemistry-based molecular model accurately predicts ESCC patient survival and thus could serve as a complement to current clinical risk stratification approaches. PMID:25153136

Wu, Jian-Yi; Shen, Jin-Hui; Xu, Xiu-E; Fu, Jun-Hui; Wu, Zhi-Yong; Li, En-Min; Xu, Li-Yan

2014-01-01

259

Robot assisted thoracoscopic resection of giant esophageal leiomyoma  

PubMed Central

INTRODUCTION Esophageal leiomyoma represents the most common benign esophageal tumor. Robot-assisted thoracoscopic surgery has provided ability to remove it successfully using a minimally invasive approach. PRESENTATION OF CASE A 63-year old female with history of chronic chest pain presented with an esophageal mass on chest CT and endoscopic ultrasound. Robot-assisted surgery was performed using three robot arms, a camera and an assistant port. A 10 cm leiomyoma was enucleated and removed through a 2 cm myotomy. Completion endoscopy confirmed integrity of the esophagus. Patient's chest pain resolved postoperatively, and she was discharged on postoperative day 3. DISCUSSION Our case describes successful removal of the giant esophageal leiomyoma (10 cm) by robot assisted minimally invasive resection through a 2 cm myotomy. CONCLUSION Use of robot allows for removal of large esophageal leiomyoma. The improved dexterity and patient outcome offered by robot suggests its potential as the mainstay technique for giant esophageal leiomyoma removal. PMID:25460487

Compean, Steven D.; Gaur, Puja; Kim, Min P.

2014-01-01

260

Carbonated Soft Drink Consumption and Risk of Esophageal Adenocarcinoma  

Microsoft Academic Search

Carbonated soft drinks (CSDs) have been associated with gastroesophageal refl ux, an established risk factor for esophageal adenocarcinoma. As both CSD consumption and esophageal ade- nocarcinoma incidence have sharply increased in recent decades, we exam- ined CSD as a risk factor for esophageal and gastric cancers in a U.S. multi- center, population-based case-control study. Associations between CSD intake and risk

Susan T. Mayne; Harvey A. Risch; Robert Dubrow; Wong-Ho Chow; Marilie D. Gammon; Thomas L. Vaughan; Lauren Borchardt; Janet B. Schoenberg; Janet L. Stanford; A. Brian West; Heidi Rotterdam; William J. Blot; Joseph F. Fraumeni

2006-01-01

261

Thoracoscopic esophageal atresia repair made easy. An applicable trick.  

PubMed

Thoracoscopic repair of esophageal atresia is becoming more popular but technical difficulties in handsewn anastomosis still remain challenging. This article presents an easy and applicable maneuver by passing the trans-esophageal tube before starting to suture in order to minimize the gap, reduce the tension over primary sutures and provide a better visualization of posterolateral parts of the anastomosis in thoracoscopic esophageal atresia repair. Using this maneuver makes tying easier and minimizes grasping and crushing damages to the anastomotic site. PMID:23480935

Hiradfar, Mehran; Shojaeian, Reza; Gharavi Fard, Mohammad; Joodi, Marjan; Sabzevari, Alireza; Nazarzade, Reza

2013-03-01

262

Correlation Between Number of Eosinophils and Reflux Index on Same Day Esophageal Biopsy and 24 Hour Esophageal pH Monitoring  

Microsoft Academic Search

OBJECTIVE:The presence of eosinophils on esophageal biopsy is a marker of esophagitis in children. Eosinophilic inflammation without evidence of gastroesophageal reflux has led to the new diagnosis of eosinophilic, or allergic, esophagitis. The aim of this study was to correlate the number of eosinophils with the reflux index on same day esophageal biopsy and 24 h esophageal pH monitoring.METHODS:A retrospective

Steven J. Steiner; Sandeep K. Gupta; Joseph M. Croffie; Joseph F. Fitzgerald

2004-01-01

263

Esophageal Motor Disorders in Terms of High-Resolution Esophageal Pressure Topography: What Has Changed?  

PubMed Central

The concept of high-resolution manometry (HRM) is to use sufficient pressure sensors such that intraluminal pressure can be monitored as a continuum along luminal length much as time is viewed as a continuum in conventional manometry. When HRM is coupled with pressure topography plots, pressure amplitude is transformed into spectral colors with isobaric conditions indicated by same-colored regions on the display. Together, these technologies are called high-resolution esophageal pressure topography (HREPT). HREPT has several advantages compared with conventional manometry, the technology that it was designed to replace. (i) The contractility of the entire esophagus can be viewed simultaneously in a uniform format, (ii) standardized objective metrics can be systematically applied for interpretation, and (iii) topographic patterns of contractility are more easily recognized and have greater reproducibility than with conventional manometry. Compared with conventional manometry, HREPT has improved sensitivity for detecting achalasia, largely due to the objectivity and accuracy with which it identifies impaired esophagogastric junction (EGJ) relaxation. In addition, it has led to the subcategorization of achalasia into three clinically relevant subtypes based on the contractile function of the esophageal body: classic achalasia, achalasia with esophageal compression, and spastic achalasia. Headway has also been made in understanding hypercontractile conditions, including diffuse esophageal spasm and a newly described entity, spastic nutcracker. Ultimately, clinical experience will be the judge, but it seems likely that HREPT data, along with its well-defined functional implications, will improve the clinical management of esophageal motility disorders. PMID:20179690

Kahrilas, Peter J.

2010-01-01

264

Desmoglein-1 regulates esophageal epithelial barrier function and immune responses in eosinophilic esophagitis  

PubMed Central

The desmosomal cadherin desmoglein-1 (DSG1) is an essential intercellular adhesion molecule that is altered in various human cutaneous disorders; however, its regulation and function in allergic disease remains unexplored. Herein, we demonstrate a specific reduction in DSG1 in esophageal biopsies from patients with eosinophilic esophagitis (EoE), an emerging allergic disorder characterized by chronic inflammation within the esophageal mucosa. Further, we show that DSG1 gene silencing weakens esophageal epithelial integrity, and induces cell separation and impaired barrier function (IBF) despite high levels of desmoglein-3 (DSG3). Moreover, DSG1 deficiency induces transcriptional changes that partially overlap with the transcriptome of inflamed esophageal mucosa; notably, periostin, a multipotent pro-inflammatory extracellular matrix molecule, is the top induced overlapping gene. We further demonstrate that IBF is a pathological feature in EoE, which can be partially induced through the downregulation of DSG1 by interleukin-13 (IL-13). Taken together, these data identify a functional role for DSG1 and its dysregulation by IL-13 in the pathophysiology of EoE and suggest that the loss of DSG1 may potentiate allergic inflammation through the induction of pro-inflammatory mediators such as periostin. PMID:24220297

Sherrill, J D; KC, K; Wu, D; Djukic, Z; Caldwell, J M; Stucke, E M; Kemme, K A; Costello, M S; Mingler, M K; Blanchard, C; Collins, M H; Abonia, J P; Putnam, P E; Dellon, E S; Orlando, R C; Hogan, S P; Rothenb, M E

2014-01-01

265

A sequence variant in the phospholipase C epsilon C2 domain is associated with esophageal carcinoma and esophagitis.  

PubMed

A single-nucleotide polymorphism (rs2274223: A5780G:His1927Arg) in the phospholipase C epsilon gene (PLC?) was recently identified as a susceptibility locus for esophageal cancer in Chinese subjects. To determine the underlying mechanisms of PLC? and this SNP in esophageal carcinogenesis, we analyzed PLC? genotypes, expression, and their correlation in esophageal cancer cell lines, non-transformed esophageal cells, 58 esophageal squamous cell carcinomas and 10,614 non-cancer subjects from China. We found that the G allele (AG or GG) was associated with increased PLC? mRNA and protein expression in esophageal cancer tissues and in esophageal cancer cell lines. G allele was also associated with higher enzyme activity, which might be associated with increased protein expression. Quantitative analysis of the C2 domain sequences revealed that A:G allelic imbalance was strongly linked to esophageal malignancy. Moreover, the analysis of 10,614 non-cancer subjects demonstrated that the G allele was strongly associated with moderate to severe esophagitis in the subjects from the high-incidence areas of China (OR 6.03, 95% CI 1.59-22.9 in high-incidence area vs. OR 0.74, 95% CI 0.33-1.64 in low-incidence area; P?=?0.008). In conclusion, the PLC? gene, particularly the 5780G allele, might play a pivotal role in esophageal carcinogenesis via upregulating PLC? mRNA, protein, and enzyme activity, and augmenting inflammatory process in esophageal epithelium. Thus, 5780G allele may constitute a promising biomarker for esophageal squamous cell carcinoma risk stratification, early detection, and progression prediction. PMID:23390063

Wang, Li-Dong; Bi, Xiuli; Song, Xin; Pohl, Nicole M; Cheng, Yulan; Zhou, Yixing; Shears, Stephen; Ansong, Emmanuel; Xing, Mengtao; Wang, Shaomeng; Xu, Xiao-Chun; Huang, Peng; Xu, Liyan; Wang, Liang; Fan, Zongmin; Zhao, Xueke; Dong, Huali; Meltzer, Stephen J; Ding, Ivan; Yang, Wancai

2013-11-01

266

Eosinophils in the Esophagus—Peptic or Allergic Eosinophilic Esophagitis? Case Series of Three Patients with Esophageal Eosinophilia  

Microsoft Academic Search

OBJECTIVES:Scattered eosinophils in the distal esophagus traditionally provide the hallmark for peptic esophagitis, but the upper limit of eosinophils and the longitudinal extent of peptic inflammation along the esophagus are unknown. Recently, adults and children with upper intestinal symptoms and >20 eosinophils\\/high-power field (eos\\/HPF) have been given the diagnosis of allergic esophagitis. Standardized diagnostic criteria for allergic esophagitis are lacking

Peter Ngo; Glenn T. Furuta; Donald A. Antonioli; Victor L. Fox

2006-01-01

267

Advances in the management of early esophageal carcinoma.  

PubMed

Esophageal squamous cell cancer (ESCC) has a dismal prognosis mainly because its recognition in Western countries usually occurs in late stages, when the possibilities of cure are minimal. However, in recent years, several advances have been observed in the management of ESSC, such as the identification of high-risk patients, the use of high-resolution endoscopy and lugol chromoscopy favoring the diagnosis of early stage ESCC, and the development of endoluminal techniques of en-block tumor resection, namely endoscopic submucosal dissection (ESD). These factors have enabled the application of endoscopic minimally invasive curative interventions in selected patients with superficial ESCC. This review article, designed by a multicenter international group, has the primary objective to provide a comprehensive overview of the most important recent advances in the management of ESCC. Secondarily it intends to provide a detailed and practical description of the technical approach to ESD in order to facilitate the dissemination of this concept and the incorporation of this new technologies in Brazil and in Latin-America. PMID:23348652

Arantes, Vitor; Forero Piñeros, Elias Alfonso; Yoshimura, Ken; Toyonaga, Takashi

2012-12-01

268

Comprehensive study of DNA binding on iron (II,III) oxide nanoparticles with a positively charged polyamine three-dimensional coating.  

PubMed

Iron (II,III) oxide Fe3O4 nanoparticles (25 and 50 nm NPs) are grafted with amine groups through silanization in order to generate a positively charged coating for binding negatively charged species including DNA molecules. The spatial nature of the coating changes from a 2-D-functionalized surface (monoamines) through a layer of amine oligomers (diethylenetriamine or DETA, about 1 nm in length) to a 3-D layer of polyamine (polyethyleneimine or PEI, thickness ?3.5 nm). These Fe3O4-PEI NPs were prepared by binding short-chain PEI polymers to the iodopropyl groups grafted on the NP surface. In this work, the surface charge density, or zeta potential, of the nanoparticles is found not to be the only factor influencing the DNA binding capacity, which also seems not to be affected by their buffering capacity profile in the range of pH 4-10. This study also allows the investigation of this 3-D effect on the surface of a nanoparticle as opposed to conventional 2-D amine functionalization. The flexibility of the PEI coating, which consists of only 1, 2, and 3° amines, on the nanoparticle surface has a significant influence on the overall DNA binding capacity and the binding efficiency (or N/P ratio). These polyamine-functionalized nanoparticles can be used in the purification of biomolecules and the delivery of drugs and large biomolecules. PMID:23941510

Yiu, Humphrey H P; Bouffier, Laurent; Boldrin, Paul; Long, James; Claridge, John B; Rosseinsky, Matthew J

2013-09-10

269

Low-level detections of Sudan I, II, III and IV in spices and Chili-containing foodstuffs using UPLC-ESI-MS/MS.  

PubMed

Sudan dyes are red, synthetic azo dyes that are not allowed in foodstuffs in the European Union (Council Directive 94/36/EC). However, subppm levels of Sudan dye in spices are regularly reported, and it is assumed that these appearances are due to cross-contamination. In this paper, we present a newly developed fast and sensitive method for the quantification of Sudan I, II, III, and IV, using liquid-liquid extraction and UPLC-MS/MS analysis, and giving quantification limits ranging from 2.5 to 200 ?g/kg. The method was applied to 21 samples, and 17 of them contained Sudan dye at low concentrations (3.3-8 709 ?g/kg). Interestingly, it was observed that the distribution of Sudan dye in the sample is not homogeneous, which may lead to false negatives or to overestimations of the concentration, and that the pretreatment (blending or not) of the sample seriously influences the final result of the analysis. PMID:23390927

Schummer, Claude; Sassel, Jeannine; Bonenberger, Pascale; Moris, Gilbert

2013-03-01

270

Three-Dimensional Localization of the ? and ? Subunits and of the II-III Loop in the Skeletal Muscle L-type Ca2+ Channel*  

PubMed Central

The L-type Ca2+ channel (dihydropyridine receptor (DHPR) in skeletal muscle acts as the voltage sensor for excitation-contraction coupling. To better resolve the spatial organization of the DHPR subunits (?1s or CaV1.1, ?2, ?1a, ?1, and ?), we created transgenic mice expressing a recombinant ?1a subunit with YFP and a biotin acceptor domain attached to its N- and C- termini, respectively. DHPR complexes were purified from skeletal muscle, negatively stained, imaged by electron microscopy, and subjected to single-particle image analysis. The resulting 19.1-? resolution, three-dimensional reconstruction shows a main body of 17 × 11 × 8 nm with five corners along its perimeter. Two protrusions emerge from either face of the main body: the larger one attributed to the ?2-?1 subunit that forms a flexible hook-shaped feature and a smaller protrusion on the opposite side that corresponds to the II-III loop of CaV1.1 as revealed by antibody labeling. Novel features discernible in the electron density accommodate the atomic coordinates of a voltage-gated sodium channel and of the ? subunit in a single docking possibility that defines the ?1-? interaction. The ? subunit appears more closely associated to the membrane than expected, which may better account for both its role in localizing the ?1s subunit to the membrane and its suggested role in excitation-contraction coupling. PMID:23118233

Szpyt, John; Lorenzon, Nancy; Perez, Claudio F.; Norris, Ethan; Allen, Paul D.; Beam, Kurt G.; Samsó, Montserrat

2012-01-01

271

Tetra-?-acetato-?O:O'-bis-[(3-cyano-pyridine-?N)ruthenium(II,III)](Ru-Ru) hexa-fluoridophosphate 1,2-dichloro-ethane monosolvate.  

PubMed

The title compound, [Ru(2)(CH(3)CO(2))(4)(C(6)H(4)N(2))(2)]PF(6)·C(2)H(4)Cl(2), was obtained via a rapid substitution reaction in 2-propanol whereby 3-cyano-pyridine replaces the axial water mol-ecules in the diaquatetra-?-acetato-diruthenium(II,III) hexa-fluorido-phosphate starting material. The product rapidly precipated and crystals were grown from 1,2-dichloro-ethane. The 1,2-dichloro-ethane mol-ecule of solvation exhibits disorder with two different orientations [occupancy ratio 0.51?(6):0.49?(6)]. All three parts, the cation, the anion and the disordered solvent mol-ecule lie on crystallographic inversion centers. The Ru-Ru bond length of 2.2702?(6)?Å fits nicely into the range seen for similar complexes and correlates well with the reduction potential of the complex and donor strength of the axial ligand, 3-cyano-pyridine, as postulated in a previous study [Vamvounis et al. (2000 ?). Inorg. Chim. Acta, 305, 87-98]. The 3-cyano-pyridine ligands orient themselves in an anti configuration with respect to each other and the Ru-Ru-N angle [174.27?(7)°] is close to being linear. PMID:22219795

Minaker, Samuel A; Wang, Ruiyao; Aquino, Manuel A S

2011-11-01

272

alpha-Galactosidases II, III and IV from seeds of Trifolium repens. Purification, physicochemical properties and mode of galactomannan hydrolysis in vitro.  

PubMed Central

Five alpha-galactosidases (alpha-D-galactoside galactohydrolase, EC 3.2.1.22) were identified by chromatography and by their different electrophoretic mobilities, in the germinated seeds of Trifolium repens (white clover). alpha-Galactosidases II, III and IV were purified to homogeneity, with increases in specific activity of approx. 4600-, 4900- and 2800-fold respectively. The enzymes were purified by a procedure that included (NH4)2SO4 precipitation, hydroxyapatite, Sephadex G-75 and DEAE-cellulose chromatography, and preparative polyacrylamide-gel disc electrophoresis. The purified enzymes showed a single protein band, corresponding to the alpha-galactosidase activity, when examined by polyacrylamide-gel electrophoresis. The pH optimum was determined with o-nitrophenyl alpha-D-galactoside and the galactomannan of T. repens To as substrate. All three enzymes are highly thermolabile. Hydrolysis of oligosaccharides and galactomannans was examined, including two galactomannans from the germinated seed of T. repens (T24 and T36). By sodium dodecyl sulphate/polyacrylamide-gel electrophoresis the mol.wts. of the multiple forms of enzyme were found to be identical (41 000). PMID:33663

Williams, J; Villarroya, H; Petek, F

1978-01-01

273

Survival Rate of Esophageal Carcinoma in Iran - A Systematic Review and Meta-analysis  

PubMed Central

Background Esophageal cancer is often diagnosed in the last stages where the chance of patient’s survival is very low. The aim of this systematic review was presentation of valid estimation of survival in patients with esophageal cancer in different regions of Iran. Methods A systematic review was carried out based on the reliable domestic medical databases including: SID, Magiran, Irandoc and Iranmedex as well as reliable foreign databases like PubMed and Scopus using “Cancer”, “Esophagus”, “survival” “Neoplasms” and “Longevity” as keywords. Then all the reviewed articles and dissertations which met the entry criteria were analyzed. The data were analyzed by using meta-analysis method (random model) and by means of STATA software application version 11.1. Results In 18 studies the total numbers of 2932 people were analyzed. The one year survival rate in Iran is estimated at 47 percent (95% CI: 34-61) and the five year survival rate is estimated at 12% (95% CI: 8-16). The two, three and four year survival rates were 31% (95% CI: 18-44), 22% (95% CI: 13-31) and 21% (95% CI: 4-38), respectively. Conclusion According to the findings one year survival rate for esophageal cancer in Iran is almost four times higher than its five year survival rate. Moreover the five year survival rate in Iran is less than many other countries. PMID:25250151

Yarhusseini, Amir; Sharifzadeh, Loghman; Delpisheh, Ali; Veisani, Yousef; Sayehmiri, Fatemeh; Sayehmiri, Kourosh

2014-01-01

274

Genomic Alterations in Advanced Esophageal Cancer May Lead to Subtype-Specific Therapies  

PubMed Central

The development of targeted agents for metastatic esophageal or gastroesophageal junction (GEJ) tumors has been limited when compared with that for other common tumors. To date, the anti-human epidermal growth factor receptor-2 (HER-2) antibody, trastuzumab, in combination with chemotherapy, is the only approved novel agent for these cancers, and its use is limited to the small population of patients whose tumors overexpress HER-2. Despite recent progress in the field, median overall survival remains only 8–12 months for patients with stage IV esophageal or GEJ cancer. In this article, we examine the molecular aberrations thought to drive the development and spread of esophageal cancer and identify promising targets for specific tumor inhibition. Data from clinical studies of targeted agents are reviewed, including epidermal growth factor receptor antibodies, tyrosine kinase inhibitors, HER-2, and vascular endothelial growth factor-directed therapy. Current and future targets include MET, fibroblast growth factor receptor, and immune-based therapies. Evidence from trials to date suggests that molecularly unselected patient cohorts derive minimal benefit from most target-specific agents, suggesting that future collaborative investigation should focus on preselected molecular subgroups of patients with this challenging heterogeneous disease. PMID:23853247

Forde, Patrick M.

2013-01-01

275

New genetic links in eosinophilic esophagitis.  

PubMed

Eosinophilic esophagitis (EoE) is increasingly diagnosed as a disorder throughout the world. It is characterized by eosinophils in the esophagus due to food allergies. Molecular analysis of esophageal biopsies and mouse models have indicated a clear role for the T helper 2 pathway, in particular interleukins 5 and 13, in this disease. Current treatment options for EoE involve avoidance of the allergens or using anti-inflammatory medications such as topical corticosteroids. In the past year, genomic research has led to the identification of single nucleotide polymorphisms in the gene encoding thymic stromal lymphopoietin (TSLP), and subsequently in the gene encoding its receptor, as disease susceptibility markers for EoE. Identification of this molecule and its receptor suggest the potential for new treatment options in the future. PMID:20822553

Spergel, Jonathan M

2010-01-01

276

Esophageal atresia and prenatal exposure to mycophenolate.  

PubMed

Mycophenolate mofetil is a widely prescribed immunosuppressive agent for transplant patients and autoimmune diseases. Potential teratogenic effects after in utero exposure to mycophenolate mofetil has been described in human clinical observations. The complete clinical pattern is still being delineated. We present four newborns with esophageal atresia and other congenital anomalies, prenatally exposed to mycophenolate mofetil during the first trimester. Two of the cases had other defects related to the embryopathy: microtia, eye abnormalities and oral clefts. Two cases did not show major craniofacial anomalies. We propose that esophageal atresia with or without tracheoesophageal fistula is a feature of mycophenolate embryopathy even without the presence of other major craniofacial anomalies. The human teratogenicity of MMF is reinforced by this report, and the current contraceptive recommendations about its use in fertile women are stressed. PMID:25461910

Martín, M C; Cristiano, E; Villanueva, M; Bonora, M L; Berguio, N; Tocci, A; Groisman, B; Bidondo, M P; Liascovich, R; Barbero, P

2014-12-01

277

Peroral endoscopic myotomy for esophageal achalasia.  

PubMed

Peroral endoscopic myotomy (POEM) is one of the alternative treatment for achalasia. Due to concept of natural orifice transluminal endoscopic surgery (NOTES), it becomes popular and widely accepted. With the endoluminal technique, submucosal tunnel was created followed by endoscopic myotomy. POEM is not only indicated in classical achalasia but also other abnormal esophageal motility disorders. Moreover, failures of endoscopic treatment or surgical attempted cases are not contraindicated for POEM. The second attempted POEM is also safe and technically feasible. Even though the legend of success of POEM is fruitful, the possible complications are very frightened. Good training and delicate practice will reduce rate of complications. This review provides a summary of current state-of-the-art of POEM, including indication equipments, technique and complications. This perfect procedure may become the treatment of choice of achalasia and some esophageal motility disorders in the near future. PMID:25333007

Phalanusitthepha, Chainarong; Inoue, Haruhiro; Ikeda, Haruo; Sato, Hiroki; Sato, Chiaki; Hokierti, Chananya

2014-03-01

278

Current strategies in chemoradiation for esophageal cancer  

PubMed Central

Chemoradiotherapy (CRT) has an important role in the treatment of esophageal cancer in both the inoperable and the pre-operative settings. Pre-operative chemoradiation therapy is generally given to 41.4-50.4 Gy with platinum or paclitaxel based chemotherapy. The most common definitive dose in the U.S. is 50-50.4 Gy. New advances in CRT for esophageal cancer have come from looking for ways to minimize toxicity and maximize efficacy. Recent investigations for minimizing toxicity have focused advanced radiation techniques such as IMRT and proton therapy, have sought to further define normal tissue tolerances, and have examined the use of tighter fields with less elective clinical target volume coverage. Efforts to maximize efficacy have included the use of early positron emission tomography (PET) response directed therapy, molecularly targeted therapies, and the use of tumor markers that predict response. PMID:24982764

Lloyd, Shane

2014-01-01

279

Peroral endoscopic myotomy for esophageal achalasia  

PubMed Central

Peroral endoscopic myotomy (POEM) is one of the alternative treatment for achalasia. Due to concept of natural orifice transluminal endoscopic surgery (NOTES), it becomes popular and widely accepted. With the endoluminal technique, submucosal tunnel was created followed by endoscopic myotomy. POEM is not only indicated in classical achalasia but also other abnormal esophageal motility disorders. Moreover, failures of endoscopic treatment or surgical attempted cases are not contraindicated for POEM. The second attempted POEM is also safe and technically feasible. Even though the legend of success of POEM is fruitful, the possible complications are very frightened. Good training and delicate practice will reduce rate of complications. This review provides a summary of current state-of-the-art of POEM, including indication equipments, technique and complications. This perfect procedure may become the treatment of choice of achalasia and some esophageal motility disorders in the near future. PMID:25333007

Inoue, Haruhiro; Ikeda, Haruo; Sato, Hiroki; Sato, Chiaki; Hokierti, Chananya

2014-01-01

280

Aortoesophageal fistula secondary to reflux esophagitis.  

PubMed

Aortoenteric fistula is a rare cause of massive upper gastrointestinal bleeding and is in the overwhelming majority of cases due to erosion of a suture line of a prosthetic vascular graft into the bowel. We report the case of a massive fatal gastrointestinal hemorrhage from an aortoenteric fistula secondary to erosion from reflux esophagitis. Proper management requires expedient radiographic and endoscopic evaluation, and even with appropriate management mortality remains extremely high. PMID:17369684

Podbielski, Francis J; Rodriguez, Heron E; Zhu, Richard Y; Worley, Todd A; Fontaine, Jacques Pierre; Connolly, Mark M

2007-01-01

281

Esophageal food impaction: treatment with glucagon.  

PubMed

Nineteen patients who had foreign bodies in the distal esophagus were examined prospectively to determine the efficacy of intravenous glucagon in relieving the obstruction. The administration of glucagon resulted in clearance of the impacted food in seven patients. Although the success rate is relatively low, the risk is minimal and justifiable. Use of intravenous glucagon is a safe, worthwhile initial step in the treatment of distal esophageal foreign bodies. PMID:6622682

Trenkner, S W; Maglinte, D D; Lehman, G A; Chernish, S M; Miller, R E; Johnson, C W

1983-11-01

282

Ambulatory Esophageal pH Monitoring  

Microsoft Academic Search

Extraesophageal manifestations of gastroesophageal reflux may be best diagnosed using ambulatory esophageal pH monitoring. This test involves the placemenmt of a thin pH probe in the esophagus, which is connected to a small box on a waistbelt. Studies are done in an ambulatory state in the patient’s home and work environment. Data collected assesses acid exposure time over the circadian

Joel E Richter

1997-01-01

283

Esophageal squamous cell carcinoma: Pathology and prognosis  

Microsoft Academic Search

Between 1985 and 1992 a total of 403 patients with resected thoracic esophageal squamous cell carcinoma were evaluated histopathologically, and various pathologic findings related to survival were examined. Concerning depth of tumor invasion, 8 (2%) cases were pTis, 110 (27%) were pT1, 48 (12%) were pT2, 202 (50%) were pT3, and 35 (9%) were pT4. Lymphatic invasion was detected in

Hiroko Ide; Tsutomu Nakamura; Kazuhiko Hayashi; Takeshi Endo; Ataru Kobayashi; Reiki Eguchi; Fujio Hanyu

1994-01-01

284

Salicylic acid ingestion leading to esophageal stricture.  

PubMed

Accidental ingestion of caustic substances (acid and alkali) occurs more frequently in children than in adults. The subsequent injury varies from minimal to severe, with perforation and even death as potential complications. Several factors have been shown to mediate the severity of injury, including the pH, concentration and physical state of the ingested substance, tissue contact time, and quantity (volume) of the ingested material. Liquids with a pH of less than 2 (acidic) or a pH of greater than 12 (alkali) are considered to be extremely corrosive and hold the greatest risk for injury. Esophageal injury after caustic ingestion is endoscopically graded with a score of 0 for no injury to IIIb for significant circumferential injury with ulcers and necrosis. Ingestion of either a strong alkali or acid has been documented to result in esophageal necrosis and ulcers (grade IIIb). Alkali ingestions occur more frequently because of their presence in daily life (detergents, degreasers) and therefore have more reports of injury. Despite more than 8200 documented cases of topical salicylic acid ingestions annually in US children younger than 19 years, there are no reported cases of salicylic acid resulting in gastrointestinal pathology. We report 2 cases of salicylic acid ingestion resulting in esophageal strictures. Both patients had more significant injury than anticipated given their initial clinical presentations. Given our recent experience, we recommend close follow-up and evaluation for strictures in patients with exposure to salicylic acid. PMID:20145508

Waasdorp Hurtado, Christine E; Kramer, Robert E

2010-02-01

285

Esophageal duplication cyst containing a foreign body  

PubMed Central

About 10% to 15% of all duplication cysts in the alimentary tract are esophageal. Esophageal duplication cysts are intimately attached to the alimentary tract, are lined by mucous membrane and have smooth muscle. This paper describes a 2-year-old child who presented with symptoms of progressive respiratory distress. A diagnosis of esophageal duplication cyst was made. At surgery a low cervical incision was made and the sternal manubrium split, thereby providing adequate exposure. The cyst was then removed. The most useful investigations were chest roentgenography and barium esophagography. Computerized tomography showed a small, round foreign body in the middle of the cyst that was subsequently found to be a bingo chip. Communication between the cyst and the esophagus was not obvious at the time of surgery and had not been demonstrated by barium esophagography. When complete excision of the cyst is not possible because of inflammatory reaction all the mucosa must be removed to prevent recurrence. Careful postoperative respiratory support and broad-spectrum antibiotic therapy are recommended. ImagesFig. 1Fig. 2Fig. 3 PMID:3971270

Stringel, Gustavo; Mercer, Stanley; Briggs, Valerie

1985-01-01

286

Cancer Staging  

MedlinePLUS

... is called metastasis. 2. What are the common elements of staging systems? Staging systems for cancer have ... others focus on a particular type. The common elements considered in most staging systems are as follows: ...

287

Over-expression of lysine-specific demethylase 1 predicts tumor progression and poor prognosis in human esophageal cancer  

PubMed Central

Lysine specific demethylase 1 (LSD1), the first characterized histone demethylase, roles importantly in epigenetic regulation of carcinogenesis and cancer progression. In the present study, we examined LSD1 expression in 103 cases of esophageal cancer tissues, and further investigated its relationship to patient’s clinical parameters and post-operative prognosis. We found that the positive LSD1 immunochemical staining was predominantly observed on the nuclei and cytoplasm of esophageal cancer cells, while negative or very weak in adjacent normal tissues. The intensity of LSD1 immunostaining was significantly correlated to the tumor size (P = 0.013), nodal metastasis (P = 0.002), distant metastasis (P = 0.025), and TNM stage (P = 0.010), whereas it was not correlated to patient’s gender, age and tumor invasion depth. The overall survival rate of patients with low LSD1 expression was better than those with high LSD1 expression (P = 0.014). We also showed that the tumor size (P = 0.003) as well as the TNM stage (P = 0.007) was a useful prognostic predictor for esophageal cancer. However, when the gender, age, tumor size, TNM stage and LSD1 expression level were involved in the multivariate proportional hazards regression analysis in a Cox’s model, we showed that the tumor size (P = 0.013) and the TNM stage (P = 0.032) could be used as independent risk factors to predict patient’s postoperative prognosis, but LSD1 expression level as well as other factors could not independently predict patient’s outcome. Thus, our results indicated that LSD1 was involved in cancer progression and metastasis in human esophageal cancer, and could be a potential prognostic predictor for this malignancy.

Chen, Lujun; Xu, Yun; Xu, Bin; Deng, Haifeng; Zheng, Xiao; Wu, Changping; Jiang, Jingting

2014-01-01

288

Systematic review of health-related quality of life after esophagectomy for esophageal cancer  

PubMed Central

This study is aimed to assess the long-term health-related quality of life (HRQL) of patients after esophagectomy for esophageal cancer in comparison with es-tablished norms, and to evaluate changes in HRQL during the different stages of follow-up after esophageal resection. A systematic review was performed by searching medical databases (Medline, Embase and the Cochrane Library) for potentially relevant studies that appeared between January 1975 and March 2011. Studies were included if they addressed the question of HRQL after esophageal resection for esophageal cancer. Two researchers independently performed the study selection, data extraction and analysis processes. Twenty-one observational studies were included with a total of 1282 (12-355) patients. Five studies were performed with short form-36 (SF-36) and 16 with European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 (14 of them also utilized the disease-specific OES18 or its previous version OES24). The analysis of long-term generic HRQL with SF-36 showed pooled scores for physical, role and social function after esophagectomy similar to United States norms, but lower pooled scores for physical function, vitality and general health perception. The analysis of HRQL conducted using the Global EORTC C30 global scale during a 6-mo follow-up showed that global scale and physical function were better at the baseline. The symptom scales indicated worsened fatigue, dyspnea and diarrhea 6 mo after esophagectomy. In contrast, however, emotional function had significantly improved after 6 mo. In conclusion, short- and long-term HRQL is deeply affected after esophagectomy for cancer. The impairment of physical function may be a long-term consequence of esophagectomy involving either the respiratory system or the alimentary tract. The short- and long-term improvement in the emotional function of patients who have undergone successful operations may be attributed to the impression that they have survived a near-death experience. PMID:22180708

Scarpa, Marco; Valente, Stefano; Alfieri, Rita; Cagol, Matteo; Diamantis, Giorgio; Ancona, Ermanno; Castoro, Carlo

2011-01-01

289

Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration  

SciTech Connect

Background: Chemo-radiotherapy for thoracic tumors can result in high-grade radiation esophagitis. Treatment planning to reduce esophageal irradiation requires organ motion to be accounted for. In this study, esophageal mobility was assessed using four-dimensional computed tomography (4DCT). Methods and Materials: Thoracic 4DCT scans were acquired on a 16-slice CT scanner in 29 patients. The outer esophageal wall was contoured in two extreme phases of respiration in 9 patients with nonesophageal malignancies. The displacement of the center of contour was measured at 2-cm intervals. In 20 additional patients with Stage I lung cancer, the esophagus was contoured in all 10 phases of each 4DCT at five defined anatomic levels. Both approaches were then applied to 4DCT scans of 4 patients who each had two repeat scans performed. A linear mixed effects model was constructed with fixed effects: measurement direction, measurement type, and measurement location along the cranio-caudal axis. Results: Measurement location and direction were significant descriptive parameters (Wald F-tests, p < 0.001), and the interaction term between the two was significant (p = 0.02). Medio-lateral mobility exceeded dorso-ventral mobility in the lower half of the esophagus but was of a similar magnitude in the upper half. Margins that would have incorporated all movement in medio-lateral and dorso-ventral directions were 5 mm proximally, 7 mm and 6 mm respectively in the mid-esophagus, and 9 mm and 8 mm respectively in the distal esophagus. Conclusions: The distal esophagus shows more mobility. Margins for mobility that can encompass all movement were derived for use in treatment planning, particularly for stereotactic radiotherapy.

Dieleman, Edith [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Senan, Suresh [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)]. E-mail: s.senan@vumc.nl; Vincent, Andrew [Department of Bioinformatics, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Lagerwaard, Frank J. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Slotman, Ben J. [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Soernsen de Koste, John R. van [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)

2007-03-01

290

Preoperative Cetuximab, Irinotecan, Cisplatin, and Radiation Therapy for Patients With Locally Advanced Esophageal Cancer  

PubMed Central

Purpose. To determine the efficacy and toxicity of weekly neoadjuvant cetuximab combined with irinotecan, cisplatin, and radiation therapy in patients with locally advanced esophageal or gastroesophageal junction cancer. Methods and Materials. Patients with stage IIA–IVA esophageal or gastroesophageal junction cancer were enrolled in a Simon's two-stage phase II study. Patients received weekly cetuximab on weeks 0–8 and irinotecan and cisplatin on weeks 1, 2, 4, and 5, with concurrent radiotherapy (50.4 Gy on weeks 1–6), followed by surgical resection. Results. In the first stage, 17 patients were enrolled, 16 of whom had adenocarcinoma. Because of a low pathologic complete response (pCR) rate in this cohort, the trial was discontinued for patients with adenocarcinoma but squamous cell carcinoma patients continued to be enrolled; two additional patients were enrolled before the study was closed as a result of poor accrual. Of the 19 patients enrolled, 18 patients proceeded to surgery, and 16 patients underwent an R0 resection. Three patients (16%) had a pCR. The median progression-free survival interval was 10 months, and the median overall survival duration was 31 months. Severe neutropenia occurred in 47% of patients, and severe diarrhea occurred in 47% of patients. One patient died preoperatively from sepsis, and one patient died prior to hospital discharge following surgical resection. Conclusions. This schedule of cetuximab in combination with irinotecan, cisplatin, and radiation therapy was toxic and did not achieve a sufficient pCR rate in patients with localized esophageal adenocarcinoma to undergo further evaluation. PMID:23429739

Lee, Michael S.; Mamon, Harvey J.; Hong, Theodore S.; Choi, Noah C.; Fidias, Panagiotis M.; Kwak, Eunice L.; Meyerhardt, Jeffrey A.; Ryan, David P.; Bueno, Raphael; Donahue, Dean M.; Jaklitsch, Michael T.; Lanuti, Michael; Rattner, David W.; Fuchs, Charles S.

2013-01-01

291

Prevention of esophageal strictures after endoscopic submucosal dissection.  

PubMed

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have recently been accepted as less invasive methods for treating patients with early esophageal cancers such as squamous cell carcinoma and dysplasia of Barrett's esophagus. However, the large defects in the esophageal mucosa often cause severe esophageal strictures, which dramatically reduce the patient's quality of life. Although preventive endoscopic balloon dilatation can reduce dysphagia and the frequency of dilatation, other approaches are necessary to prevent esophageal strictures after ESD. This review describes several strategies for preventing esophageal strictures after ESD, with a particular focus on anti-inflammatory and tissue engineering approaches. The local injection of triamcinolone acetonide and other systemic steroid therapies are frequently used to prevent esophageal strictures after ESD. Tissue engineering approaches for preventing esophageal strictures have recently been applied in basic research studies. Scaffolds with temporary stents have been applied in five cases, and this technique has been shown to be safe and is anticipated to prevent esophageal strictures. Fabricated autologous oral mucosal epithelial cell sheets to cover the defective mucosa similarly to how commercially available skin products fabricated from epidermal cells are used for skin defects or in cases of intractable ulcers. Fabricated autologous oral-mucosal-epithelial cell sheets have already been shown to be safe. PMID:25386058

Kobayashi, Shinichiro; Kanai, Nobuo; Ohki, Takeshi; Takagi, Ryo; Yamaguchi, Naoyuki; Isomoto, Hajime; Kasai, Yoshiyuki; Hosoi, Takahiro; Nakao, Kazuhiko; Eguchi, Susumu; Yamamoto, Masakazu; Yamato, Masayuki; Okano, Teruo

2014-11-01

292

Population Attributable Risks of Esophageal and Gastric Cancers  

Microsoft Academic Search

Background: Several risk factors have been identified for esophageal adenocarcinoma, gastric cardia adenocarcinoma, esophageal squamous cell carcinoma, and noncardia gastric adenocarcinoma, but no study has comprehensively exam- ined their contributions to the cancer burden in the general population. Herein, we estimate the population attributable risks (PARs) for various risk factors observed in a multi- center population-based case-control study. Methods: We

Lawrence S. Engel; Wong-Ho Chow; Thomas L. Vaughan; Marilie D. Gammon; Harvey A. Risch; Janet L. Stanford; Janet B. Schoenberg; Susan T. Mayne; Robert Dubrow; Heidrun Rotterdam; A. Brian West; Martin Blaser; William J. Blot; Mitchell H. Gail; Joseph F. Fraumeni

2003-01-01

293

Congenital distal esophageal obstruction caused by intraluminal mucosal web.  

PubMed

Here, we report a case with intraluminal membrane (web) located in the lower esophagus causing complete obstruction. Esophagogram revealed complete obstruction near the esophagogastric junction. Surgical excision of the esophageal membrane was performed. To our knowledge, only a few cases with membranous esophageal atresia have been reported. It must be remembered in neonates who cannot tolerate feeding. PMID:23094548

U?uralp, Sema; Ceran, Canan; Demircan, Mehmet

2012-01-01

294

Endoscopic Management of Difficult or Recurrent Esophageal Strictures  

Microsoft Academic Search

Esophageal strictures are a common problem in gastroenterological practice. In general, the management of malignant or benign esophageal strictures is different and requires a different treatment approach. In daily clinical practice, stent placement is a commonly used modality for the palliation of incurable malignant strictures causing dysphagia, whereas, if available, intraluminal brachytherapy can be considered in patients with a good

Laetitia R H de Wijkerslooth; Frank P Vleggaar; Peter D Siersema

2011-01-01

295

Pierre Robin sequence with esophageal atresia and congenital radioulnar synostosis.  

PubMed

A wide spectrum of anomalies can be associated with Pierre Robin sequence. This report presents a 3-day-old infant with micrognathia, U-shaped cleft palate, low-set right ear with microtia, glossoptosis, esophageal atresia, and right congenital radioulnar synostosis. The association of congenital radioulnar synostosis and esophageal atresia with Pierre Robin sequence has not been previously described. PMID:16681404

Ozkan, Keramettin Ugur; Coban, Yusuf Kenan; Uzel, Murat; Ergun, Mehmet; Oksuz, Hafize

2006-05-01

296

The efficacy of ozone therapy in experimental caustic esophageal burn  

Microsoft Academic Search

IntroductionOzone has been proposed as an antioxidant enzyme activator, immunomodulator and cellular metabolic activator. This study was designed to investigate the efficacy of ozone therapy in the prevention of esophageal damage and stricture formation developed after esophageal caustic injuries in the rat.

Ahmet Guven; Gokhan Gundogdu; Serdar Sadir; Turgut Topal; Esra Erdogan; Ahmet Korkmaz; ?lhami Surer; Haluk Ozturk

2008-01-01

297

Photodynamic Therapy for Barrett's Esophagus and Esophageal Carcinoma  

PubMed Central

This paper reviews the use of photodynamic therapy (PDT) in patients with Barrett's esophagus and esophageal carcinoma. We describe the history of PDT, mechanics, photosensitizers for PDT in patients with esophageal disease. Finally, we discuss its utility and limitations in this setting. PMID:23423151

Qumseya, Bashar J.; David, Waseem

2013-01-01

298

Management of patients with combined tracheoesophageal fistula, esophageal atresia, and duodenal atresia  

PubMed Central

INTRODUCTION Patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia (DA) pose a rare management challenge. PRESENTATION OF CASE Three patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia safely underwent a staged approach inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week. None of the patients suffered significant pre- or post-operative complications and our follow-up data (between 12 and 24 months) suggest that all patients eventually outgrow their reflux and respiratory symptoms. DISCUSSION While some authors support repair of all defects in one surgery, we recommend a staged approach. A gastrostomy tube is placed first for gastric decompression before TEF ligation and EA repair can be safely undertaken. The repair of the DA can then be performed within 3–7 days under controlled circumstances. CONCLUSION A staged approach of inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week resulted in excellent outcomes. PMID:25460495

Nabzdyk, Christoph S.; Chiu, Bill; Jackson, Carl-Christian; Chwals, Walter J.

2014-01-01

299

The efficacy of self-expanding metal stents for palliation of malignant esophageal strictures and fistulas  

Microsoft Academic Search

Objectives: Esophageal strictures and esophagorespiratory fistulas are complications of malignant esophageal tumors, which are difficult to manage. The efficacy of self-expanding metal stents (SEMS) for palliation of malignant esophageal strictures and fistulas was investigated prospectively. Methods: Forty-three SEMS were inserted in 41 patients with malignant esophageal stricture or fistula. Our series included 32 men and nine women, of whom median

Alpay Sarper; Necdet Oz; Cemalettin Cihangir; Abid Demircan; Erol Isin

2003-01-01

300

Relationship of esophageal anastomotic tension to the development of gastroesophageal reflux  

Microsoft Academic Search

Background\\/Purpose: Gastroesophageal reflux (GER) is a common occurrence after repair of congenital esophageal atresia and is believed to be more frequent when the esophageal anastomosis is performed under tension. This study documents that esophageal anastomotic tension correlates directly with the severity of acid reflux into the esophagus in the rabbit model.Methods: Eight adult rabbits underwent complete esophageal transection with immediate

Weihong Guo; Eric W Fonkalsrud; Fresca Swaniker; Anatoly Kodner

1997-01-01

301

Predictors of recurrence free survival for patients with stage II and III colon cancer  

PubMed Central

Background The aim of this study was to evaluate clinico-pathologic specific predictors of recurrence for stage II/III disease. Improving recurrence prediction for resected stage II/III colon cancer patients could alter surveillance strategies, providing opportunities for more informed use of chemotherapy for high risk individuals. Methods 871 stage II and 265 stage III patients with colon cancers were included. Features studied included surgery date, age, gender, chemotherapy, tumor location, number of positive lymph nodes, tumor differentiation, and lymphovascular and perineural invasion. Time to recurrence was evaluated, using Cox’s proportional hazards models. The predictive ability of the multivariable models was evaluated using the concordance (c) index. Results For stage II cancer patients, estimated recurrence-free survival rates at one, three, five, and seven years following surgery were 98%, 92%, 90%, and 89%. Only T stage was significantly associated with recurrence. Estimated recurrence-free survival rates for stage III patients at one, three, five, and seven years following surgery were 94%, 78%, 70%, and 66%. Higher recurrence rates were seen in patients who didn’t receive chemotherapy (p?=?0.023), with a higher number of positive nodes (p?stage II model was 0.55 and 0.68 for stage III. Conclusions Current clinic-pathologic information is inadequate for prediction of colon cancer recurrence after resection for stage II and IIII patients. Identification and clinical use of molecular markers to identify the earlier stage II and III colon cancer patients at elevated risk of recurrence are needed to improve prognostication of early stage colon cancers. PMID:24886281

2014-01-01

302

Molecular basis of multiple sulfatase deficiency, mucolipidosis II/III and Niemann-Pick C1 disease - Lysosomal storage disorders caused by defects of non-lysosomal proteins.  

PubMed

Multiple sulfatase deficiency (MSD), mucolipidosis (ML) II/III and Niemann-Pick type C1 (NPC1) disease are rare but fatal lysosomal storage disorders caused by the genetic defect of non-lysosomal proteins. The NPC1 protein mainly localizes to late endosomes and is essential for cholesterol redistribution from endocytosed LDL to cellular membranes. NPC1 deficiency leads to lysosomal accumulation of a broad range of lipids. The precise functional mechanism of this membrane protein, however, remains puzzling. ML II, also termed I cell disease, and the less severe ML III result from deficiencies of the Golgi enzyme N-acetylglucosamine 1-phosphotransferase leading to a global defect of lysosome biogenesis. In patient cells, newly synthesized lysosomal proteins are not equipped with the critical lysosomal trafficking marker mannose 6-phosphate, thus escaping from lysosomal sorting at the trans Golgi network. MSD affects the entire sulfatase family, at least seven members of which are lysosomal enzymes that are specifically involved in the degradation of sulfated glycosaminoglycans, sulfolipids or other sulfated molecules. The combined deficiencies of all sulfatases result from a defective post-translational modification by the ER-localized formylglycine-generating enzyme (FGE), which oxidizes a specific cysteine residue to formylglycine, the catalytic residue enabling a unique mechanism of sulfate ester hydrolysis. This review gives an update on the molecular bases of these enigmatic diseases, which have been challenging researchers since many decades and so far led to a number of surprising findings that give deeper insight into both the cell biology and the pathobiochemistry underlying these complex disorders. In case of MSD, considerable progress has been made in recent years towards an understanding of disease-causing FGE mutations. First approaches to link molecular parameters with clinical manifestation have been described and even therapeutical options have been addressed. Further, the discovery of FGE as an essential sulfatase activating enzyme has considerable impact on enzyme replacement or gene therapy of lysosomal storage disorders caused by single sulfatase deficiencies. PMID:19124046

Dierks, Thomas; Schlotawa, Lars; Frese, Marc-André; Radhakrishnan, Karthikeyan; von Figura, Kurt; Schmidt, Bernhard

2009-04-01

303

Japanese POEMS syndrome with Thalidomide (J-POST) Trial: study protocol for a phase II/III multicentre, randomised, double-blind, placebo-controlled trial  

PubMed Central

Introduction Polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes (POEMS) syndrome is a fatal systemic disorder associated with plasma cell dyscrasia and the overproduction of the vascular endothelial growth factor (VEGF). Recently, the prognosis of POEMS was substantially improved by introduction of therapeutic intervention for myeloma. However, no randomised clinical trial has been performed because of the rarity and severity of the disease. Methods and analysis The Japanese POEMS syndrome with Thalidomide (J-POST) Trial is a phase II/III multicentre, double-blinded, randomised, controlled trial that aims to evaluate the efficacy and safety of a 24-week treatment with thalidomide in POEMS syndrome, with an additional 48-week open-label safety study. Adults with POEMS syndrome who have no indication for transplantation are assessed for eligibility at 12 tertiary neurology centres in Japan. Patients who satisfy the eligibility criteria are randomised (1:1) to receive thalidomide (100–300?mg daily) plus dexamethasone (12?mg/m2 on days 1–4 of a 28-day cycle) or placebo plus dexamethasone. Both treatments were administered for 24?weeks (six cycles; randomised comparative study period). Patients who complete the randomised study period or show subacute deterioration during the randomised period participate in the subsequent 48-week open-label safety study (long-term safety period). The primary end point of the study is the reduction rate of serum VEGF levels at 24?weeks. Ethics and dissemination The protocol was approved by the Institutional Review Board of each hospital. The trial was notified and registered at the Pharmaceutical and Medical Devices Agency, Japan (No. 22-1716). The J-POST Trial is currently ongoing and is due to finish in August 2015. The findings of this trial will be disseminated through peer-reviewed publications and conference presentations and will also be disseminated to participants. Trial registration number UMIN000004179 and JMA-IIA00046. PMID:25573527

Katayama, Kanako; Misawa, Sonoko; Sato, Yasunori; Sobue, Gen; Yabe, Ichiro; Watanabe, Osamu; Nishizawa, Masatoyo; Kusunoki, Susumu; Kikuchi, Seiji; Nakashima, Ichiro; Ikeda, Shu-ichi; Kohara, Nobuo; Kanda, Takashi; Kira, Jun-ichi; Hanaoka, Hideki; Kuwabara, Satoshi

2015-01-01

304

Activation of 5-HT receptors inhibits GABAergic transmission by pre-and post-synaptic mechanisms in layer II/III of the juvenile rat auditory cortex.  

PubMed

The specific mechanisms by which serotonin (5-HT) modulates synaptic transmission in the auditory cortex are still unknown. In this work, we used whole-cell recordings from layer II/III of pyramidal neurons in rat brain slices to characterize the influence of 5-HT on inhibitory synaptic activity in the auditory cortex after pharmacological blockade of excitatory glutamatergic transmission. We found that bath application of 5-HT (5 µM) reduced the frequency and amplitude of both spontaneous and miniature inhibitory postsynaptic currents (IPSCs), reduced the amplitude of evoked IPSCs, and enhanced facilitation of paired pulse ratio (PPR), suggesting presynaptic inhibition. To determine which the serotonin receptors were involved in this effect, we studied the influence of specific 5-HT receptor agonists and antagonists on ?-aminobutyric acid (GABA)ergic synaptic transmission. The inhibiting influence of 5-HT in the GABAergic synaptic activity was mimicked by using the selective agonists of the 5-HT1A and 5-HT2A receptors, 8(OH)-DPAT (10 µM) and DOI (10 µM), respectively; and it was prevented by their respective antagonists NAN-190 (1 µM) and ritanserin (1 ?M). Furthermore, the application of the selective agonist of 5-HT1A receptors, 8-(OH)-DPAT (10 µM), produced PPR facilitation, while DOI application (5-HT2A agonist) did not change the PPR. Moreover, the 5-HT2A agonist reduced the amplitude of the IPSCs evoked by application of the selective GABA agonist, muscimol. These results suggest a presynaptic and postsynaptic reduction of GABAergic transmission mediated by 5-HT1A and 5-HT2A serotonergic receptors, respectively. Synapse 69:115-127, 2015. ?© 2014 Wiley Periodicals, Inc. PMID:25482075

García-Oscos, Francisco; Torres-Ramírez, Oswaldo; Dinh, Lu; Galindo-Charles, Luis; Pérez Padilla, Elsy Arlene; Pineda, Juan Carlos; Atzori, Marco; Salgado, Humberto

2015-03-01

305

Simultaneous esophageal pH monitoring and scintigraphy during the postprandial period in patients with severe reflux esophagitis  

Microsoft Academic Search

To compare reflux events detected by intraesophageal pH monitoring with that of scintigraphy, we simultaneously performed both techniques along with esophageal manometry in nine patients with severe reflux esophagitis. Two hundred eighteen reflux events were detected in the recumbent posture after a meal during a 40-min interval. Both techniques simultaneously detected only 23% of all reflux events. Scintigraphy alone detected

Steven S. Shay; Douglas Eggli; Lawrence F. Johnson

1991-01-01

306

Removable esophageal stents have poor efficacy for the treatment of refractory benign esophageal strictures (RBES).  

PubMed

With the recent availability of removable esophageal stents, endoscopic stenting has been utilized to treat refractory benign esophageal strictures (RBES). The objective of this study was to review the feasibility and effectiveness of removable esophageal stents to treat RBES. Patients who received removable esophageal stents for the treatment of RBES at the institution between 2004-2010 using its stent implantation logs and endoscopic database were retrospectively identified. Patient demographics, stricture etiology and location, stent and procedure characteristics, and clinical outcomes were obtained. Twenty-five patients with a mean age of 70 (72% male) underwent initial stent placement; 24 were successful. Overall clinical success was achieved in five of the 19 patients (26%) ultimately undergoing stent removal. RBES etiologies included anastomotic (13), radiation (5), peptic (3), chemotherapy (1), scleroderma (1), and unknown (2). Alimaxx-E (Merit-Endotek, South Jordan, UT, USA) stents were placed in 20 patients and Polyflex (Boston Scientific, Natick, MA, USA) stents were used in five patients. Immediate complications included failed deployment (1) and chest pain (7). Five patients died prior to stent removal. Stent migration was found in 53% (10/19) of patients who underwent stent removal: nine required additional therapy and one had symptom resolution. Out of the nine patients without stent migration, five required additional therapy and four had symptom resolution. Although placement of removable esophageal stents for RBES is technically feasible, it is frequently complicated by stent migration and chest pain. In addition, few patients achieved long-term stricture resolution after initial stenting. In this study, most patients ultimately required repeated stenting and/or dilations to maintain relief of dysphagia. PMID:23121426

Dan, D T; Gannavarapu, B; Lee, J G; Chang, K; Muthusamy, V R

2014-08-01

307

Siglec-F Inhibition Reduces Esophageal Eosinophilia and Angiogenesis in a Mouse Model of Eosinophilic Esophagitis  

PubMed Central

Objectives Eosinophilic esophagitis (EoE) is a disorder characterized histologically by tissue eosinophilia. Sialic acid–binding immunoglobulin-like lectin (Siglec-F) is a receptor highly expressed on mouse eosinophils and mediates eosinophilic apoptosis. We investigated whether administration of an anti-Siglec-F Ab would reduce esophageal eosinophilic inflammation and remodeling in a mouse model of egg ovalbumin (OVA)–induced EoE. Subjects and Methods Three groups of mice were studied (no OVA, OVA + anti-Siglec-F Ab, and OVA + isotype control Ab). Mice were sensitized intraperitoneally and then challenged chronically with intraesophageal OVA. Levels of esophageal eosinophils and features of remodeling (angiogenesis, vascular endothelial growth factor expression, deposition of fibronectin, basal zone hyperplasia, and fibrosis) were quantitated by immunohistochemistry and image analysis. Results Administration of an anti-Siglec-F Ab to OVA-challenged mice significantly reduced levels of esophageal eosinophils, down to levels noted in non-OVA-challenged mice. The anti-Siglec-F Ab also reduced features of OVA-induced remodeling, including angiogenesis, basal zone hyperplasia, and fibronectin deposition. The reduced angiogenesis in anti-Siglec-F Ab-treated mice was associated with reduced numbers of vascular endothelial growth factor–positive cells in the esophagus. The anti-Siglec-F antibody did not significantly reduce esophageal fibrosis as assessed by trichrome staining. Conclusions Administration of an anti-Siglec-F antibody significantly decreased the number of eosinophils in the esophagus in a mouse model of OVA-induced EoE. The reduction in eosinophilic inflammation was associated with a significant decrease in levels of angiogenesis, deposition of fibronectin, and basal zone hyperplasia. Studies in this pre-clinical model of EoE suggest that Siglec-F (and its human paralog Siglec-8) may be novel therapeutic targets to reduce eosinophilic inflammation in EoE. PMID:21970996

Rubinstein, Eitan; Cho, Jae Youn; Rosenthal, Peter; Chao, James; Miller, Marina; Pham, Alexa; Aceves, Seema S.; Varki, Ajit; Broide, David H.

2014-01-01

308

Esophageal candidiasis in AIDS. Successful therapy with clotrimazole vaginal tablets taken by mouth.  

PubMed

In this paper we describe the results of oral therapy of esophageal candidiasis with clotrimazole vaginal tablets in 25 homosexual men with AIDS, of whom 19 had oral candidiasis and 16 had esophageal symptoms. Therapy with clotrimazole vaginal tablets, 100 mg, taken by mouth cleared the esophageal symptoms, oral candidiasis, and esophageal lesions completely in all 25 men. Clotrimazole vaginal tablets are a useful alternative to other antifungal agents for the treatment of esophageal candidiasis in AIDS patients. PMID:1995261

Lalor, E; Rabeneck, L

1991-03-01

309

Pathophysiological mechanisms linking obesity and esophageal adenocarcinoma  

PubMed Central

In recent decades there has been a dramatic rise in the incidence of esophageal adenocarcinoma (EAC) in the developed world. Over approximately the same period there has also been an increase in the prevalence of obesity. Obesity, especially visceral obesity, is an important independent risk factor for the development of gastro-esophageal reflux disease, Barrett’s esophagus and EAC. Although the simplest explanation is that this mediated by the mechanical effects of abdominal obesity promoting gastro-esophageal reflux, the epidemiological data suggest that the EAC-promoting effects are independent of reflux. Several, not mutually exclusive, mechanisms have been implicated, which may have different effects at various points along the reflux-Barrett’s-cancer pathway. These mechanisms include a reduction in the prevalence of Helicobacter pylori infection enhancing gastric acidity and possibly appetite by increasing gastric ghrelin secretion, induction of both low-grade systemic inflammation by factors secreted by adipose tissue and the metabolic syndrome with insulin-resistance. Obesity is associated with enhanced secretion of leptin and decreased secretion of adiponectin from adipose tissue and both increased leptin and decreased adiponectin have been shown to be independent risk factors for progression to EAC. Leptin and adiponectin have a set of mutually antagonistic actions on Barrett’s cells which appear to influence the progression of malignant behaviour. At present no drugs are of proven benefit to prevent obesity associated EAC. Roux-en-Y reconstruction is the preferred bariatric surgical option for weight loss in patients with reflux. Statins and aspirin may have chemopreventative effects and are indicated for their circulatory benefits. PMID:25400997

Alexandre, Leo; Long, Elizabeth; Beales, Ian LP

2014-01-01

310

Microbiome, innate immunity, and esophageal adenocarcinoma.  

PubMed

With the development of culture-independent technique, a complex microbiome has been established and described in the distal esophagus. The incidence of esophageal adenocarcinoma (EAC) has increased dramatically in the United States. Studies documenting an altered microbiome associated with EAC and its precedents suggest that dysbiosis may be contributing to carcinogenesis, potentially mediated by interactions with toll-like receptors. Investigations attempting to associate viruses with EAC have not been as consistent. Currently available data are cross-sectional and therefore cannot prove causal relationships. Prospectively, microbiome studies open a new avenue to the understanding of the etiology and pathogenesis of reflux disorders and EAC. PMID:25439272

Baghdadi, Jonathan; Chaudhary, Noami; Pei, Zhiheng; Yang, Liying

2014-12-01

311

Emerging Therapeutic Options for Eosinophilic Esophagitis  

PubMed Central

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus that often occurs in atopic persons. Management strategies include pharmacotherapy, dietary modification, and endoscopic therapy, although patients will often have a relapsing and remitting course. Currently, the primary pharmacotherapy for EoE consists of corticosteroids. Immuno-modulators, leukotriene antagonists, biologies, and monoclonal antibodies are currently under study for treatment of EoE. The role of immunoglobulin E-mediated allergic reactions has been well documented and may provide insight into the etiology and effective therapy of EoE. PMID:24803874

Dougherty, Timothy; Stephen, Sindu; Borum, Marie L.

2014-01-01

312

Eponyms in esophageal surgery, part 2.  

PubMed

Eponyms in medicine are frequently criticized because they may not represent the person who first described a syndrome or disease. Although eponyms are very commonly used, most readers are probably unaware of who it was that named the diseases and whether the original description of the disease still corresponds to the modern definition. The 10 most common eponyms in esophageal diseases were revisited. The men and the disease behind Barrett's esophagus, Boerhaave's syndrome, Mallory-Weiss syndrome, Cameron ulcer, Schatzki ring, Paterson-Kelly syndrome, Plummer-Vinson, Chagas's disease, Zenker diverticulum and Killian diverticulum are reviewed here. PMID:15773835

Herbella, F A M; Matone, J; Del Grande, J C

2005-01-01

313

Esophageal stricture in a cougar (Puma concolor).  

PubMed

A 7-mo-old female cougar (Puma concolor) was presented with a 2-wk history of anorexia and a 1-wk history of regurgitation. Barium contrast esophagogram and gastroesophagoscopy revealed the presence of a segmental intraluminal esophageal stricture in the middle third of the esophagus. The stricture was potentially secondary to a previous anesthetic episode. Three endoscopic balloon dilations allowed increasing the luminal diameter to a size that enabled the cougar to eat food softened with water without any signs of discomfort or regurgitation. Two months after being discharged, the cougar was doing well, had gained weight and was eating horsemeat softened with water. PMID:19569481

Desmarchelier, Marion; Lair, Stéphane; Defarges, Alice; Lécuyer, Manon; Langlois, Isabelle

2009-06-01

314

Influence of Ionizing Radiation on Stromal-Epithelial Intercellular Communication in Esophageal Carcinogenesis  

NASA Technical Reports Server (NTRS)

Esophageal cancer is the 6th leading cause of cancer death worldwide. Its development is associated with a variety of risk factors including tobacco use, heavy alcohol consumption, human papilloma virus infection, and certain dietary factors such as trace mineral and vitamin deficiencies. An association with ionizing radiation exposure is revealed by the high excess relative risk for squamous cell carcinoma of the esophagus observed in the survivors of the atomic bomb detonations in Japan. It is also seen as a secondary malignancy in patients who received radiotherapy for breast and thoracic cancers; additionally, patients with head/neck and oral squamous cell cancers are at increased risk for metachronous esophageal squamous cell cancers. This malignancy is rapidly fatal, mainly because it remains asymptomatic until late, advanced stages when the disease is rarely curable. The stromal microenvironment plays an essential role in the maintenance and modulation of normal epithelial cell growth and differentiation and cross talk between the epithelial and stromal compartments can influence many aspects of malignant progression, including tumor cell proliferation, migration, invasion and recruitment of new blood vessels. To test the hypothesis that radiation exposure plays a role in esophageal carcinogenesis via non-targeted mechanisms involving stromal-epithelial cell communication, we are studying radiation effects on hTERT-immortalized human esophageal epithelial cells and genetic variants grown in co-culture with human esophageal stromal fibroblasts (Okawa et al., Genes & Dev. 2007. 21: 2788-2803). We examined how radiation treatment of stromal fibroblasts affected epithelial migration and invasion, behaviors associated with cancer promotion and progression. Chemotactic and haptotactic migration of epithelial cells stimulated by conditioned media from irradiated fibroblasts was measured using assays conducted in Transwell cell culture chambers. Our results using low LET radiation showed a dose-dependent increase in migration of epithelial cells when exposed to conditioned media from irradiated vs. non-irradiated fibroblasts. We also observed enhanced invasion through a basement membrane simulant. To identify chemotactic proteins secreted by irradiated stromal fibroblasts, we used antibody capture cytokine arrays and have identified several proteins as candidates. Increased secretion of these factors by irradiated fibroblasts was confirmed using ELISA. We are currently analyzing the contribution of these individual factors on epithelial migration and invasion, as well as their influence on cell survival and DNA repair. Studies using high-LET radiation will help determine radiation quality effects on these processes. These results should further our understanding of the mechanisms by which radiation impacts the tissue microenvironment and how it influences cancer development processes.

Patel, Zarana S.; Kalabis, Jiri; Rustgi, Anil K.; Cucinotta, Francis A.; Huff, Janice L.

2010-01-01

315

Clinical and endoscopic characteristics of drug-induced esophagitis  

PubMed Central

AIM: To investigate clinical, endoscopic and pathological characteristics of drug-induced esophagitis. METHODS: Data for patients diagnosed with drug-induced esophagitis from April 2002 to May 2013 was reviewed. Patients diagnosed with malignancy, viral or fungal esophagitis were excluded. Clinical, endoscopic and pathological characteristics of patients diagnosed with drug-induced esophagitis were analyzed. RESULTS: Seventy-eight patients were diagnosed with drug-induced esophagitis. Their mean age was 43.9 ± 18.9 years and 35.9% were male. Common symptoms were chest pain (71.8%), odynophagia (38.5%) and dysphagia (29.5%). The endoscopic location was in the middle third of esophagus in 78.2%. Endoscopic findings were ulcer (82.1%), erosion (17.9%), ulcer with bleeding (24.4%), coating with drug material (5.1%), impacted pill fragments (3.8%) and stricture (2.6%). Kissing ulcers were observed in 43.6%. The main causative agents were antibiotics and non-steroidal anti-inflammatory drugs. All the patients were treated with proton pump inhibitors (PPIs) or sucralfate, and the causative drugs were discontinued. Nineteen patients with drug-induced esophagitis were followed up with endoscopy and revealed normal findings, scars or healing ulcers. CONCLUSION: Drug-induced esophagitis mainly presents as chest pain, odynophagia and dysphagia, and may be successfully treated with PPIs and discontinuation of the causative drug. Kissing ulcers were observed in 43.6%. PMID:25152603

Kim, Su Hwan; Jeong, Ji Bong; Kim, Ji Won; Koh, Seong-Joon; Kim, Byeong Gwan; Lee, Kook Lae; Chang, Mee Soo; Im, Jong Pil; Kang, Hyoun Woo; Shin, Cheol Min

2014-01-01

316

Esophageal hypomotility and spastic motor disorders: current diagnosis and treatment.  

PubMed

Esophageal hypomotility (EH) is characterized by abnormal esophageal peristalsis, either from a reduction or absence of contractions, whereas spastic motor disorders (SMD) are characterized by an increase in the vigor and/or propagation velocity of esophageal body contractions. Their pathophysiology is not clearly known. The reduced excitation of the smooth muscle contraction mediated by cholinergic neurons and the impairment of inhibitory ganglion neuronal function mediated by nitric oxide are likely mechanisms of the peristaltic abnormalities seen in EH and SMD, respectively. Dysphagia and chest pain are the most frequent clinical manifestations for both of these dysfunctions, and gastroesophageal reflux disease (GERD) is commonly associated with these motor disorders. The introduction of high-resolution manometry (HRM) and esophageal pressure topography (EPT) has significantly enhanced the ability to diagnose EH and SMD. Novel EPT metrics in particular the development of the Chicago Classification of esophageal motor disorders has enabled improved characterization of these abnormalities. The first step in the management of EH and SMD is to treat GERD, especially when esophageal testing shows pathologic reflux. Smooth muscle relaxants (nitrates, calcium channel blockers, 5-phosphodiesterase inhibitors) and pain modulators may be useful in the management of dysphagia or pain in SMD. Endoscopic Botox injection and pneumatic dilation are the second-line therapies. Extended myotomy of the esophageal body or peroral endoscopic myotomy (POEM) may be considered in highly selected cases but lack evidence. PMID:25376746

Valdovinos, Miguel A; Zavala-Solares, Monica R; Coss-Adame, Enrique

2014-11-01

317

The effect of concurrent esophageal pathology on bariatric surgical planning.  

PubMed

In the presence of esophageal pathology, there is risk of worse outcomes after laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG). This study reviewed how an esophageal workup affected a bariatric operative plan in patients with concurrent esophageal pathology. We retrospectively reviewed patients planning bariatric surgery referred with significant reflux, dysphagia, and hiatal hernia (>3 cm) to determine how and why a thorough esophageal workup changed a bariatric operative plan. We identified 79 patients for analysis from 2009 to 2013. In 10/41 patients (24.3 %) planning LAGB and 5/9 patients planning SG (55.5 %), a Roux was preferred because of severe symptoms of reflux and aspiration, dysphagia, manometric abnormalities (aperistaltic or hypoperistaltic esophagus with low mean wave amplitudes), large hiatal hernia (>5 cm), and/or presence of Barrett's esophagus. Patients without these characteristics had a decreased risk of foregut symptoms after surgery. We recommend a thorough esophageal workup in bariatric patients with known preoperative esophageal pathology. The operative plan might need to be changed to a Roux to prevent adverse outcomes including dysphagia, severe reflux, or suboptimal weight loss. An esophageal workup may improve surgical decision making and improve patient outcomes. PMID:25213580

Bradley, Daniel Davila; Louie, Brian E; Chen, Judy; Aye, Ralph W; McMahon, Ross; Farivar, Alexander S

2015-01-01

318

New Endoscopic Indicator of Esophageal Achalasia: “Pinstripe Pattern”  

PubMed Central

Background and Study Aims Endoscopic diagnosis of esophageal achalasia lacking typical endoscopic features can be extremely difficult. The aim of this study was to identify simple and reliable early indicator of esophageal achalasia. Patients and Methods This single-center retrospective study included 56 cases of esophageal achalasia without previous treatment. As a control, 60 non-achalasia subjects including reflux esophagitis and superficial esophageal cancer were also included in this study. Endoscopic findings were evaluated according to Descriptive Rules for Achalasia of the Esophagus as follows: (1) esophageal dilatation, (2) abnormal retention of liquid and/or food, (3) whitish change of the mucosal surface, (4) functional stenosis of the esophago-gastric junction, and (5) abnormal contraction. Additionally, the presence of the longitudinal superficial wrinkles of esophageal mucosa, “pinstripe pattern (PSP)” was evaluated endoscopically. Then, inter-observer diagnostic agreement was assessed for each finding. Results The prevalence rates of the above-mentioned findings (1–5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively. PSP was observed in 60.7% of achalasia, while none of the control showed positivity for PSP. PSP was observed in 26 (62.5%) of 35 cases with shorter history < 10 years, which usually lacks typical findings such as severe esophageal dilation and tortuosity. Inter-observer agreement level was substantial for food/liquid remnant (k = 0.6861) and PSP (k = 0.6098), and was fair for abnormal contraction and white change. The accuracy, sensitivity, and specificity for achalasia were 83.8%, 64.7%, and 100%, respectively. Conclusion “Pinstripe pattern” could be a reliable indicator for early discrimination of primary esophageal achalasia. PMID:25664812

Minami, Hitomi; Isomoto, Hajime; Miuma, Satoshi; Kobayashi, Yasutoshi; Yamaguchi, Naoyuki; Urabe, Shigetoshi; Matsushima, Kayoko; Akazawa, Yuko; Ohnita, Ken; Takeshima, Fuminao; Inoue, Haruhiro; Nakao, Kazuhiko

2015-01-01

319

Vascular endothelial growth factor C (VEGF-C) in esophageal cancer correlates with lymph node metastasis and poor patient prognosis  

PubMed Central

Background The diagnosis of lymph node metastasis in esophageal cancer by the presence and number of metastatic lymph nodes is an extremely important prognostic factor. In addition, the indication of non-surgical therapy is gaining more attention. Vascular endothelial growth factor C (VEGF-C) is potentially lymphangiogenic and selectively induces hyperplasia of the lymphatic vasculature. In this study, we investigated the expression of VEGF-C and whether it correlated with various clinico-pathologic findings. Methods KYSE series of esophageal cancer cell lines and 106 patients with primary esophageal squamous cell carcinomas who had undergone radical esophagectomy were analyzed. VEGF-C mRNA expression was determined by quantitative RT-PCR. Results High expression of VEGF-C was detected in most of the KYSE cell lines, especially KYSE410, yet, in an esophageal normal epithelium cell line, Het-1A, VEGF-C was not detected. In the clinical specimen, the expression of VEGF-C in the cancerous tissue was higher than in the corresponding noncancerous esophageal mucosa (p = 0.026). The expression of VEGF-C was found to be higher in Stage2B-4A tumors than in Stage0-2A tumors (p = 0.049). When the patients were divided into two groups according to their expression levels of VEGF-C (a group of 53 cases with high expression and a group of 53 cases with low expression), the patients with high VEGF-C expression had significantly shorter survival after surgery than the patients with low expression (p = 0.0065). Although univariate analysis showed that high expression of VEGF-C was a statistically significant prognostic factor, this was not shown in multivariate analysis. In the subgroup of patients with Tis and T1 tumors, the expression of VEGF-C was higher in N1 tumors than in N0 tumors (p = 0.029). The survival rate of patients from the high expression group (n = 10) was lower than that in the low expression group (n = 11), and all the patients in the low VEGF-C expression group survived. Conclusions The expression of VEGF-C correlates with lymph node metastasis and poor prognosis. In patients with Tis and T1 esophageal tumors, the expression of VEGF-C may be a good diagnostic factor for determining metastasis of the lymph node. PMID:20584281

2010-01-01

320

Genetic landscape of esophageal squamous cell carcinoma.  

PubMed

Esophageal squamous cell carcinoma (ESCC) is one of the deadliest cancers. We performed exome sequencing on 113 tumor-normal pairs, yielding a mean of 82 non-silent mutations per tumor, and 8 cell lines. The mutational profile of ESCC closely resembles those of squamous cell carcinomas of other tissues but differs from that of esophageal adenocarcinoma. Genes involved in cell cycle and apoptosis regulation were mutated in 99% of cases by somatic alterations of TP53 (93%), CCND1 (33%), CDKN2A (20%), NFE2L2 (10%) and RB1 (9%). Histone modifier genes were frequently mutated, including KMT2D (also called MLL2; 19%), KMT2C (MLL3; 6%), KDM6A (7%), EP300 (10%) and CREBBP (6%). EP300 mutations were associated with poor survival. The Hippo and Notch pathways were dysregulated by mutations in FAT1, FAT2, FAT3 or FAT4 (27%) or AJUBA (JUB; 7%) and NOTCH1, NOTCH2 or NOTCH3 (22%) or FBXW7 (5%), respectively. These results define the mutational landscape of ESCC and highlight mutations in epigenetic modulators with prognostic and potentially therapeutic implications. PMID:25151357

Gao, Yi-Bo; Chen, Zhao-Li; Li, Jia-Gen; Hu, Xue-Da; Shi, Xue-Jiao; Sun, Zeng-Miao; Zhang, Fan; Zhao, Zi-Ran; Li, Zi-Tong; Liu, Zi-Yuan; Zhao, Yu-Da; Sun, Jian; Zhou, Cheng-Cheng; Yao, Ran; Wang, Su-Ya; Wang, Pan; Sun, Nan; Zhang, Bai-Hua; Dong, Jing-Si; Yu, Yue; Luo, Mei; Feng, Xiao-Li; Shi, Su-Sheng; Zhou, Fang; Tan, Feng-Wei; Qiu, Bin; Li, Ning; Shao, Kang; Zhang, Li-Jian; Zhang, Lan-Jun; Xue, Qi; Gao, Shu-Geng; He, Jie

2014-10-01

321

Potassium conductance in rabbit esophageal epithelium.  

PubMed

K+ conductance in apical and basolateral cell membranes of rabbit esophageal epithelial cells was investigated within intact epithelium by impalement with conventional microelectrodes from luminal or serosal sides. Under steady-state conditions, K+ conductance was demonstrated in basolateral, but not apical, membranes by showing 1) membrane depolarization upon exposure to either solutions high in K+ (20-65 mM) or containing Ba2+, tetraethylammonium, or quinine, and 2) a resistance ratio that increased on exposure to high K+ solution and decreased on exposure to Ba2+, quinine, and tetraethylammonium. From exposures to high K+, the apparent K+ transference number and electromotive force generated at the basolateral membrane were calculated and found to be 0.42 +/- 0.01 and -83 +/- 3 mV, respectively. Furthermore, basolateral K+ conductance was shown to be important for maintaining resting net transepithelial Na+ absorption in that high K+ or barium inhibited the transepithelial potential difference and short-circuit current of Ussing-chambered epithelia. We conclude that under steady-state conditions the basolateral, but not apical, membranes of esophageal epithelial cells contain a K(+)-conductive pathway and that this pathway is important for active sodium absorption. PMID:8338171

Khalbuss, W E; Alkiek, R; Marousis, C G; Orlando, R C

1993-07-01

322

Electrodes for long-term esophageal electrocardiography.  

PubMed

The emerging application of long-term and high-quality ECG recording requires alternative electrodes to improve the signal quality and recording capability of surface skin electrodes. The esophageal ECG has the potential to overcome these limitations but necessitates novel recorder and lead designs. The electrode material is of particular interest, since the material has to ensure conflicting requirements like excellent biopotential recording properties and inertness. To this end, novel electrode materials like PEDOT and silver-PDMS as well as established electrode materials such as stainless steel, platinum, gold, iridium oxide, titanium nitride, and glassy carbon were investigated by long-term electrochemical impedance spectroscopy and model-based signal analysis using the derived in vitro interfacial properties in conjunction with a dedicated ECG amplifier. The results of this novel approach show that titanium nitride and iridium oxide featuring microstructured surfaces did not degrade when exposed to artificial acidic saliva. These materials provide low electrode potential drifts and insignificant signal distortion superior to surface skin electrodes making them compatible with accepted standards for ambulatory ECG. They are superior to the noble and polarizable metals such as platinum, silver, and gold that induced more signal distortions and are superior to esophageal stainless steel electrodes that corrode in artificial saliva. The study provides rigorous criteria for the selection of electrode materials for prolonged ECG recording by combining long-term in vitro electrode material properties with ECG signal quality assessment. PMID:23649132

Niederhauser, Thomas; Haeberlin, Andreas; Marisa, Thanks; Jungo, Michael; Goette, Josef; Jacomet, Marcel; Abacherli, Roger; Vogel, Rolf

2013-09-01

323

Antesternal colonic interposition for corrosive esophageal stricture.  

PubMed

Restoration of swallowing in a patient with dysphagia due to nondilatable corrosive stricture of esophagus remains a surgical challenge. Organs available for replacement are stomach, jejunum, or colon. Jejunum is useful to replace a small segment, whereas stomach and colon are required for a long-segment replacement. In cases where the stomach is also injured, colon remains the only option. The route of colonic interposition has also been a subject of debate over the years. Antesternal, retrosternal, or esophageal bed passage are the routes described. In the present series, the data of antesternal colonic interposition (ACI) performed for nondilatable benign esophageal strictures in 32 patients (1988-2011) have been retrospectively analyzed. The results indicate that ACI for corrosive strictures is a quick and simple procedure. Thoracotomy is avoided and anastomosis is easily performed in the neck, and mortality rate due to anastomotic failure or graft failure is diminished. This retrospective analysis discusses the ease, effectiveness, quality of life, morbidity, and mortality of ACI and compares the pros and cons of ACI with other procedures described in the literature. PMID:24799785

Gvalani, Anil Kumar; Deolekar, Samir; Gandhi, Jignesh; Dalvi, Abhay

2014-02-01

324

[Management of caustic esophagitis in children].  

PubMed

In children, caustic ingestion is due to accidents at home and inadequate storage of caustic agents. In emergency, it is useful to remove the soiled clothes, rinse the affected area, and prevent vomiting and feeding. Caustic ingestion (pH<2 or>12) induces burns of the upper gastrointestinal tract requiring esophagogastro-duodenoscopy between H12 and H24. Strong alkalis cause necrosis with liquefaction of the esophagus, penetrating deeply with a high-risk of perforation. Management of these children requires a specialized care center with an intensive care unit, endoscopic equipment, and a surgical team. Esophageal stricture is the main complication; no prophylactic treatment (steroids) is effective. Strictures occur after the 3rd week, and barium swallow should be performed by the end of the 1st month. Stricture are often multiple, long, and tortuous; endoscopic dilatation is difficult with a high-rate of perforation and a low-rate of success. In situ application of mitomycin C or injection of triamcinolone could reduce the recurrence rate of stricture. In recalcitrant or recurrent strictures, it is recommended to perform an esophageal replacement using a colonic interposition or a gastric tube. Endoscopy should also be performed 15-20years after caustic ingestion to screen for early neoplastic lesions. Prevention is very important for avoiding caustic ingestions. Information and education should be given specifically to the parents of toddlers; caustic products should be stored out of reach of children and they should not be kept with food. PMID:23141564

Mas, E; Breton, A; Lachaux, A

2012-12-01

325

Esophageal Thermal Injury by Hot Adlay Tea  

PubMed Central

Reversible thermal injury to the esophagus as the result of drinking hot liquids has been reported to generate alternating white and red linear mucosal bands, somewhat reminiscent of a candy cane. This phenomenon is associated with chest pain, dysphagia, odynophagia, and epigastric pain. Here, we report a case of thermal injury to the esophageal and oral cavity due to the drinking of hot tea, including odynophagia and dysphagia. A 69-year-old man was referred due to a difficulty in swallowing which had begun a week prior to referral. The patient, at the time of admission, was unable to swallow even liquids. He had recently suffered from hiccups, and had consumed five cups of hot adlay tea one week prior to admission, as a folk remedy for the hiccups. Upon physical examination, the patient's oral cavity evidenced mucosal erosion, hyperemia, and mucosa covered by a whitish pseudomembrane. Nonspecific findings were detected on the laboratory and radiological exams. Upper endoscopy revealed diffuse hyperemia, and erosions with thick and whitish pseudomembraneous mucosa on the entire esophagus. The stomach and duodenum appeared normal. We diagnosed the patient with thermal esophageal injury inflicted by the hot tea. He was treated with pantoprazole, 40 mg/day, for 14 days, and evidenced significant clinical and endoscopic improvement. PMID:17427650

Go, Hoon; Jung, Sung Hee; Park, Young A; Lee, Jung Yun; Kim, Sae Hee; Lim, Sin Hyung

2007-01-01

326

Benign Esophageal Stricture in a Tropical African Population  

PubMed Central

In North America, the most common causes of benign esophageal stricture are hiatal hernia and reflux esophagitis. These are localized to the lower end of the esophagus. At the University College Hospital, Ibadan, Nigeria, the most common cause of benign esophageal stricture is ingestion of corrosives. The ingestion is accidental, suicidal, or for medicinal purposes. This stricture is long, narrow, and irregular. Most extend from the cervical esophagus to the cardioesophageal junction. A surgical procedure that has given good results is the use of left colon pedicled on the left colic artery for retrosternal isoperistaltic esophagocoloplasty. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:702578

Ajao, Oluwole G.; Solanke, Toriola F.

1978-01-01

327

Acute Esophageal Necrosis: An Uncommon Cause of Hematemesis  

PubMed Central

Acute esophageal necrosis or black esophagus is an uncommon clinical entity, diagnosed at the upper gastrointestinal endoscopy with the presence of strikingly black necrotic esophagus. Very often no definite etiology will be identified even though a large list of potential associations has been postulated. Upper gastrointestinal bleeding is the most common clinical presentation, others being epigastric pain, retrosternal chest discomfort and dysphagia. Only about a hundred cases of acute esophageal necrosis have been described in medical literature till this date. We report a case of acute esophageal necrosis in an elderly female who had presented with hematemesis. PMID:25170416

Zacharia, George Sarin; Sandesh, K; Ramachandran, TM

2014-01-01

328

Esophageal obstruction 14 years after treatment for Hodgkin's disease  

SciTech Connect

The incidence of late radiation injury of the esophagus is not precisely determined but, overall, the occurrence of clinically apparent damage is infrequent. The authors report a complete esophageal obstruction in a 21-year-old man, 14 years after chemo-radiation therapy for Hodgkin's lymphoma. Although endoscopy failed to demonstrate a gross morphologic abnormality, an esophagogram detected abnormal peristalsis and stricture, and esophageal manometry coupled with dynamic isotopic study clearly demonstrated a multilevel secondary neuronal damage. Data in the literature suggest that alteration in motility is by far the most frequent radiologic manifestation. Further prospective studies will probably clarify the actual incidence of late esophageal damage after chemo-radiation therapy.

Kaplinsky, C.; Kornreich, L.; Tiomny, E.; Cohen, I.J.; Loven, D.; Zaizov, R. (Beilinson Medical Center, Petah Tiqva (Israel))

1991-08-15

329

Isolated nasal tip metastasis from esophageal squamous cell carcinoma.  

PubMed

Cutaneous metastatic tumors to the nasal tip are very rare. A 74-year-old woman presented with progressive dysphagia for 4 months and a painless red violaceous nodule in the nasal tip for the last 6 weeks. Gastroendoscopy showed midesophageal wall thickening, which corresponded to esophageal squamous cell carcinoma confirmed by endoscopic biopsy. F-FDG PET/CT showed intense FDG uptake of the esophageal carcinoma (SUVmax, 19.0) and the nasal tip nodule (SUVmax, 29.1). The patient underwent biopsy of the nasal tip nodule. Nasal tip metastasis from the esophageal squamous cell carcinoma was confirmed by pathologic examination. PMID:24566414

Dong, Aisheng; Zuo, Changjing; Wang, Yang; Zhai, Zhijun; Wen, Wu

2015-01-01

330

Targeting AMCase reduces esophageal eosinophilic inflammation and remodeling in a mouse model of egg induced eosinophilic esophagitis  

PubMed Central

Studies of AMCase inhibition in mouse models of lung eosinophilic inflammation have produced conflicting results with some studies demonstrating inhibition of eosinophilic inflammation and others not. No studies have investigated the role of AMCase inhibition in eosinophilic esophagitis (EoE). We have used a mouse model of egg (OVA) induced EoE to determine whether pharmacologic inhibition of AMCase with allosamidin reduced eosinophilic inflammation and remodeling in the esophagus in EoE. Administration of intra-esophageal OVA for 6 weeks to BALB/c mice induced increased levels of esophageal eosinophils, mast cells, and features of esophageal remodeling (fibrosis, basal zone hyperplasia, deposition of the extracellular matrix protein fibronectin). Administration of intraperitoneal (ip) allosamidin to BALB/c mice significantly inhibited AMCase enzymatic activity in the esophagus. Pharmacologic inhibition of AMCase with ip allosamidin inhibited both OVA induced increases in esophageal eosinophilic inflammation and OVA induced esophageal remodeling (fibrosis, epithelial basal zone hyperplasia, extracellular matrix deposition of fibronectin). This inhibition of eosinophilic inflammation in the esophagus by ip allosamidin was associated with reduced eotaxin-1 expression in the esophagus. Oral allosamidin inhibited eosinophilic inflammation in the epithelium but did not inhibit esophageal remodeling. These studies suggest that pharmacologic inhibition of AMCase results in inhibition of eosinophilic inflammation and remodeling in the esophagus in a mouse model of egg induced EoE partially through effects in the esophagus on reducing chemokines (i.e. eotaxin-1) implicated in the pathogenesis of EoE. PMID:24239745

Cho, Jae Youn; Rosenthal, Peter; Miller, Marina; Pham, Alexa; Aceves, Seema; Sakuda, Shohei; Broide, David H

2014-01-01

331

Apolipocrustacein, formerly vitellogenin, is the major egg yolk precursor protein in decapod crustaceans and is homologous to insect apolipophorin II/I and vertebrate apolipoprotein B  

PubMed Central

Background In animals, the biogenesis of some lipoprotein classes requires members of the ancient large lipid transfer protein (LLTP) superfamily, including the cytosolic large subunit of microsomal triglyceride transfer protein (MTP), vertebrate apolipoprotein B (apoB), vitellogenin (Vtg), and insect apolipophorin II/I precursor (apoLp-II/I). In most oviparous species, Vtg, a large glycolipoprotein, is the main egg yolk precursor protein. Results This report clarifies the phylogenetic relationships of LLTP superfamily members and classifies them into three families and their related subfamilies. This means that the generic term Vtg is no longer a functional term, but is rather based on phylogenetic/structural criteria. In addition, we determined that the main egg yolk precursor protein of decapod crustaceans show an overall greater sequence similarity with apoLp-II/I than other LLTP, including Vtgs. This close association is supported by the phylogenetic analysis, i.e. neighbor-joining, maximum likelihood and Bayesian inference methods, of conserved sequence motifs and the presence of three common conserved domains: an N-terminal large lipid transfer module marker for LLTP, a DUF1081 domain of unknown function in their central region exclusively shared with apoLp-II/I and apoB, and a von Willebrand-factor type D domain at their C-terminal end. Additionally, they share a conserved functional subtilisin-like endoprotease cleavage site with apoLp-II/I, in a similar location. Conclusion The structural and phylogenetic data presented indicate that the major egg yolk precursor protein of decapod crustaceans is surprisingly closely related to insect apoLp-II/I and vertebrate apoB and should be known as apolipocrustacein (apoCr) rather than Vtg. These LLTP may arise from an ancient duplication event leading to paralogs of Vtg sequences. The presence of LLTP homologs in one genome may facilitate redundancy, e.g. involvement in lipid metabolism and as egg yolk precursor protein, and neofunctionalization and subfunctionalization, e.g. involvement in clotting cascade and immune response, of extracellular LLTP members. These protein-coding nuclear genes may be used to resolve phylogenetic relationships among the major arthropod groups, especially the Pancrustacea-major splits. PMID:17241455

Avarre, Jean-Christophe; Lubzens, Esther; Babin, Patrick J

2007-01-01

332

ABCG2/V-ATPase was associated with the drug resistance and tumor metastasis of esophageal squamous cancer cells  

PubMed Central

Background ATP-binding cassette sub-family G member 2 (ABCG2) is a protein that in humans is encoded by the ABCG2 gene. ABCG2 participates in efflux of many chemotherapeutic agents. ABCG2 is often expressed in hematopoietic progenitor or stem cells. Vacuolar-H + ?ATPase (V-ATPase) plays a key role in adjusting and maintaining intracellular pH and in regulating the drug tolerance of cells. The TNM Classification of Malignant Tumours (TNM) is a cancer staging system that describes the extent of cancer in a patient’s body. In this study, the expression of ABCG2 and V-ATPase in esophageal squamous cancer cells was detected. Methods Immunohistochemistry staining and Immunofluorescence double staining were used to detect the expression of ABCG2 and V-ATPase in in 66 cases of esophageal squamous cancer cells. Associations and differences in expression of ABCG2 with that of V-ATPase were analyzed. Results Positive staining patterns for both ABCG2 (66.67%) and V-ATPase (68.18%) were located mainly in the plasma membrane and cytoplasm. Marked differences in expression were also shown (P?stages in these carcinomas. Marked differences were also found for ABCG2 expression between the two groups in the pathological grades and in the TNM staging groups (P?stages (P?stages. Marked differences in expression of ABCG2 and V-ATPase were found between metastatic and non-metastatic groups in the same carcinomas (P?stages. Conclusions Both ABCG2 and V-ATPase were over-expressed in esophageal squamous cancer cells. Their expression was associated with pathological grade, TNM stage and tumor metastasis in esophageal squamous cancer cells, suggesting interaction relationship between them. ABCG2 and V-ATPase expression may be strongly associated with drug resistance and tumor metastasis. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3823783918433897 PMID:23244569

2012-01-01

333

Extent of lymph node dissection: common hepatic artery lymph node dissection can be omitted for esophageal squamous cell carcinoma  

PubMed Central

Objectives Controversy persists regarding the adequate extent of lymph node (LN) dissection in thoracic esophageal cancer (EC) surgery. Oncologic efficacy should be balanced with the increased risk of postoperative complications after aggressive radical LN dissection. Here, we evaluate the effectiveness of common hepatic artery LN dissection in surgery for thoracic esophageal squamous cell carcinoma. Patients and methods Among a total of 1,563 EC patients who underwent surgery from May 2005 to December 2012 at the Fudan University Shanghai Cancer Center, 1,248 thoracic esophageal squamous cell carcinoma were selected for this study, including 682 patients who underwent esophagectomy with common hepatic artery LN dissection and 566 patients who underwent esophagectomy without common hepatic artery LN dissection. The clinical data of patients were retrospectively analyzed. In addition, the locoregional LN metastasis, relationship between metastatic rates of common hepatic artery LN and clinicopathological factors were analyzed. A propensity score match analysis were performed to control for potential differences in the characteristics of patients with EC cell carcinoma, and postoperative complications were analyzed after propensity score-matching. Results The metastatic rate of common hepatic LN was 3.5%. Logistic regression analysis revealed tumor diameter, N classification and pTNM stage were risk factors for common hepatic LN metastasis. Matching based on propensity scores produced 361 patients in each group. The overall incidence of postoperative complications was 32.70% and 35.45%, respectively, no significant difference was found (P=0.432). Conclusions The metastatic rate of common hepatic artery LN is low. For patients who undergo resection for Stage I thoracic esophageal squamous cell carcinoma, the dissection of common hepatic artery LN may be safely omitted. PMID:24876938

Ma, Xiao; Li, Bin; Yang, Su; Guo, Wei; Zhu, Xiaoli; Xiang, Jiaqing; Zhang, Yawei

2014-01-01

334

Esophageal emptying and acid neutralization in patients with symptoms of esophageal reflux.  

PubMed Central

Clearance of refluxed acid from the distal esophagus is due to bolus emptying and salivary neutralization of acid. We compared results of 24-hour pH monitoring with acid clearance tests (ACT) and radioisotope swallows (RIS) in 26 symptomatic patients to determine which of the components of acid clearance is better correlated with gastroesophageal acid reflux (GER). Seven of eight patients with GER had delayed esophageal emptying on RIS. Abnormal salivary clearance of acid was present in nine of 18 patients without GER, accounting for a high false-positive rate of ACT. Delayed esophageal bolus emptying, not deficient acid neutralization by saliva, is the predominant component of abnormal acid clearance in patients with GER. RIS is superior to ACT as part of the evaluation of reflux symptoms, and may prove to be a valuable screening test for this condition. Images FIG. 2A. PMID:4004384

Ferguson, M K; Ryan, J W; Little, A G; Skinner, D B

1985-01-01

335

Multiple Rapid Swallow Responses During Esophageal High-Resolution Manometry Reflect Esophageal Body Peristaltic Reserve  

PubMed Central

OBJECTIVES Dysphagia may develop following antireflux surgery as a consequence of poor esophageal peristaltic reserve. We hypothesized that suboptimal contraction response following multiple rapid swallows (MRS) could be associated with chronic transit symptoms following antireflux surgery. METHODS Wet swallow and MRS responses on esophageal high-resolution manometry (HRM) were characterized collectively in the esophageal body (distal contractile integral (DCI)), and individually in each smooth muscle contraction segment (S2 and S3 amplitudes) in 63 patients undergoing antireflux surgery and in 18 healthy controls. Dysphagia was assessed using symptom questionnaires. The MRS/wet swallow ratios were calculated for S2 and S3 peak amplitudes and DCI. MRS responses were compared in patients with and without late postoperative dysphagia following antireflux surgery. RESULTS Augmentation of smooth muscle contraction (MRS/wet swallow ratios > 1.0) as measured collectively by DCI was seen in only 11.1% with late postoperative dysphagia, compared with 63.6% in those with no dysphagia and 78.1% in controls (P?0.02 for each comparison). Similar results were seen with S3 but not S2 peak amplitude ratios. Receiver operating characteristics identified a DCI MRS/wet swallow ratio threshold of 0.85 in segregating patients with late postoperative dysphagia from those with no postoperative dysphagia with a sensitivity of 0.67 and specificity of 0.64. CONCLUSIONS Lack of augmentation of smooth muscle contraction following MRS is associated with late postoperative dysphagia following antireflux surgery, suggesting that MRS responses could assess esophageal smooth muscle peristaltic reserve. Further research is warranted to determine if antireflux surgery needs to be tailored to the MRS response. PMID:24019081

Shaker, Anisa; Stoikes, Nathaniel; Drapekin, Jesse; Kushnir, Vladimir; Brunt, L. Michael; Gyawali, C. Prakash

2014-01-01

336

Berberine protects against esophageal mucosal damage in reflux esophagitis by suppressing proinflammatory cytokines  

PubMed Central

This study was performed to investigate the effects of berberine (BB) in a rat model of gastroesophageal reflux disease (GERD), induced by pylorus and forestomach ligation. We evaluated cytotoxicity and proinflammatory biomarkers (nitric oxide, interleukin (IL)-1? and prostaglandin E2) in RAW 264.7 cells in vitro and anti-inflammatory effects in vivo. A total of 54 Sprague Dawley rats were divided into six groups: intact control rats; reflux esophagitis (RE) control rats; RE rats treated with 20 mg/kg omeprazole and RE rats treated with BB at doses of 20, 40 and 60 mg/kg, respectively. All rats were fasted. RE was induced by pylorus and forestomach ligation one hour subsequent to the oral treatment. Six hours subsequent to the surgery, the rats were sacrificed, blood was collected from the abdominal vein and the esophagus and stomach were dissected. The gastric volume and the pH of the gastric juice were evaluated, prior to the esophagus being cut longitudinally and an inner mucosal area being imaged, to analyze mucosal damage indices. Proinflammatory biomarkers in the serum, including tumor necrosis factor (TNF)-?, IL-1?, IL-6 and monocyte chemoattractant protein (MCP)-1 were analyzed using an enzyme-linked immunosorbent assay (ELISA) kit, while the mRNA expression of TNF-?, IL-1?, IL-6 and plasminogen activator inhibitor (PAI)-1 was analyzed using a quantitative polymerase chain reaction (qPCR). Esophagic tissue damage in the BB groups was dose-dependently decreased compared with that in the RE control group. This result was consistent with significant reductions in the levels of proinflammatory biomarkers in the serum and in the expression of proinflammatory mRNA, specifically, TNF-?, IL-1?, IL-6 and PAI-1. The results suggest that the anti-inflammatory and protective effects of BB may attenuate the severity of RE and prevent esophageal mucosal damage, in addition to validating the use of BB as a pharmacological treatment for esophageal reflux disease. PMID:24137243

CHOO, BYUNG KIL; ROH, SEONG-SOO

2013-01-01

337

24Hour esophageal pH monitoring before and after medical therapy for reflux esophagitis  

Microsoft Academic Search

Medical treatment of gastroesophageal reflux disease often results in improvement of symptoms. The purpose of this study was to determine if improvement in symptoms and endoscopic appearance after treatment was associated with a reduction in reflux, as measured with 24-hr pH recordings. Twenty patients with severe chronic reflux esophagitis participated in an eight-week double-blind trial of medical therapy with metoclopramide

David A. Lieberman

1988-01-01

338

CDC2/CDK1 expression in esophageal adenocarcinoma and precursor lesions serves as a diagnostic and cancer progression marker and potential novel drug target.  

PubMed

Esophageal adenocarcinoma arises through well-defined precursor lesions (Barrett esophagus), although only a subset of these lesions advances to invasive adenocarcinoma. The lack of markers predicting progression in Barrett esophagus, typical presentation at advanced stage, and limitations of conventional chemotherapy result in >90% mortality for Barrett-associated adenocarcinomas. To identify potential prognostic markers and therapeutic targets, we compared gene expression profiles from Barrett-associated esophageal adenocarcinoma cell lines (BIC1, SEG1, KYAE, OE33) and normal esophageal epithelial scrapings utilizing the Affymetrix U133_A gene expression platform. We identified 560 transcripts with >3-fold up-regulation in the adenocarcinoma cell lines compared with normal epithelium. Utilizing tissue microarrays composed of normal esophageal squamous mucosa (n = 20), Barrett esophagus (n = 10), low-grade dysplasia (n = 14), high-grade dysplasia (n = 27), adenocarcinoma (n = 59), and node metastases (n = 27), we confirmed differential up-regulation of three proteins (Cdc2/Cdk1, Cdc5, and Igfbp3) in adenocarcinomas and Barrett lesions. Protein expression mirrored histologic progression; thus, 87% of low-grade dysplasias had at least focal surface Cdc2/Cdk1 and 20% had >5% surface staining; 96% of high-grade dysplasias expressed abundant surface Cdc2/Cdk1, while invasive adenocarcinoma and metastases demonstrated ubiquitous expression. Esophageal adenocarcinoma cell lines treated with the novel CDC2/CDK1 transcriptional inhibitor, tetra-O-methyl nordihydroguaiaretic acid (EM-1421, formerly named M4N) demonstrated a dose-dependent reduction in cell proliferation, paralleling down-regulation of CDC2/CDK1 transcript and protein levels. These findings suggest a role for CDC2/CDK1 in esophageal adenocarcinogenesis, both as a potential histopathologic marker of dysplasia and a putative treatment target. PMID:15725809

Hansel, Donna E; Dhara, Surajit; Huang, RuChih C; Ashfaq, Raheela; Deasel, Mari; Shimada, Yutaka; Bernstein, Harold S; Harmon, John; Brock, Malcolm; Forastiere, Arlene; Washington, M Kay; Maitra, Anirban; Montgomery, Elizabeth

2005-03-01

339

Novel multimodality endoscopic closure of postoperative esophageal fistula  

PubMed Central

INTRODUCTION Esophageal fistula following esophagectomy is associated with significant morbidity and mortality. PRESENTATION OF CASE We present the case of a 71-year-old man who underwent salvage Ivor-Lewis esophagectomy, following definitive chemoradiotherapy 1 year previously. On postoperative day 9 the patient complained of chest pain, and a CT scan demonstrated extravasation of oral contrast from the gastric conduit into the right chest. A right chest drain and fully covered esophageal stent were placed at this time. Despite these measures, after 8 weeks, the esophageal fistula persisted. Ultimately, fistula closure was achieved using an interventional radiology-guided, endoscopically placed over-the-scope clip (OTSC). The patient had no further complications and was well at 3 months follow-up. DISCUSSION The case reported herein describes this novel, combined-modality approach to esophageal fistula closure. CONCLUSION This case report demonstrates a novel, minimally invasive, multidisciplinary approach to the closure of a post-esophagectomy anastamotic leak. PMID:22943885

Markar, Sheraz R.; Koehler, Richard; Low, Donald E.; Ross, Andrew

2012-01-01

340

Reflux esophagitis in war-related sulfur mustard lung disease  

PubMed Central

Background Sulfur mustard (SM) has acute and chronic effects on skin and mucosal surfaces. The aim of the study was to evaluate the frequency of esophagitis in a historical cohort of veterans who had been exposed to SM in Iran-Iraq war nearly 25 years ago. Methods: One hundred two veterans with dyspepsia and/or heartburn underwent esophago-gastroduodenoscopy. Of them, 52 cases had been exposed to SM and had chronic mustard lung disease. Controls included 50 veterans without SM exposure. Esophagitis was defined according to standard criteria. Results: 81.6% of cases and 70.6% of controls had heart burn and/or regurgitation (p= 0.224). Esophagitis was seen in 40% of cases and 26.5% of controls (p= 0.155). Conclusion: Based on our findings, SM exposure seems not to be associated with increased esophagitis. PMID:25250271

Roushan, Nader; Zali, Fateme; Abtahi, Hamidreza; Asadi, Mehrnaz; Taslimi, Reza; Aletaha, Najme

2014-01-01

341

Cetuximab and Chemoradiotherapy for Locally Advanced Esophageal Cancer  

Cancer.gov

In this trial, patients with locally advanced esophageal cancer will undergo chemoradiotherapy using the drugs cisplatin and paclitaxel, and half of them will be randomly assigned to also receive the biologic agent cetuximab.

342

Fatal aorto-esophageal fistula in child: a case report.  

PubMed

Esophageal foreign body ingestion is especially frequent in childhood and may cause fatal complications in case of late diagnosis and delayed treatment. We present a case of 2-year old girl who was admitted to emergency department with massive bleeding. However, she died due to an unrecognized foreign body resulted an aorto-esophageal fistula. At autopsy an aorto-esophageal fistula was detected by gross examination. Tissue samples were obtained from the organs and fistula region. In histopathological examination, a calcified body with multinucleated giant cell and surrounding granulation tissue was detected at the bleeding site. An ulcerated fistula tract ran from the intima to the adventitia, passing through layers of esophageal wall was also noticed. The mortality rate for foreign body ingestion is less than 1%, except in cases of perforation. Therefore the presented case is among rare examples of fatal foreign body ingestions. PMID:24485434

Pehlivan, Sultan; Kara, Dogus Ozdemir; Turkkan, Dilhan; Akçan, Ramazan; Gokmen, Asude; Akduman, Baris; Karapirli, Mustafa

2014-02-01

343

Notch signaling drives stemness and tumorigenicity of esophageal adenocarcinoma.  

PubMed

Esophageal adenocarcinoma ranks sixth in cancer mortality in the world and its incidence has risen dramatically in the Western population over the last decades. Data presented herein strongly suggest that Notch signaling is critical for esophageal adenocarcinoma and underlies resistance to chemotherapy. We present evidence that Notch signaling drives a cancer stem cell phenotype by regulating genes that establish stemness. Using patient-derived xenograft models, we demonstrate that inhibition of Notch by gamma-secretase inhibitors (GSI) is efficacious in downsizing tumor growth. Moreover, we demonstrate that Notch activity in a patient's ultrasound-assisted endoscopic-derived biopsy might predict outcome to chemotherapy. Therefore, this study provides a proof of concept that inhibition of Notch activity will have efficacy in treating esophageal adenocarcinoma, offering a rationale to lay the foundation for a clinical trial to evaluate the efficacy of GSI in esophageal adenocarcinoma treatment. PMID:25164006

Wang, Zhiqiang; Da Silva, Thiago G; Jin, Ke; Han, Xiaoqing; Ranganathan, Prathibha; Zhu, Xiaoxia; Sanchez-Mejias, Avencia; Bai, Feng; Li, Bin; Fei, Dennis Liang; Weaver, Kelly; Carpio, Rodrigo Vasquez-Del; Moscowitz, Anna E; Koshenkov, Vadim P; Sanchez, Lilly; Sparling, Lynne; Pei, Xin-Hai; Franceschi, Dido; Ribeiro, Afonso; Robbins, David J; Livingstone, Alan S; Capobianco, Anthony J

2014-11-01

344

Neoadjuvant chemoradiotherapy for esophageal/gastroesophageal carcinoma  

PubMed Central

Background Esophageal/gastroesophageal junction (GEJ) adenocarcinoma is increasingly treated with trimodality therapy. We present our experience using carboplatin/paclitaxel and radiotherapy followed by surgery. Methods Consecutive patients with distal esophageal/GEJ adenocarcinoma (?T2 or N+) treated from July 2010 to October 2011 were identified. Treatment included neoadjuvant carboplatin/paclitaxel with concurrent radiotherapy (CRT) to 50.4 Gy using an IMRT technique and then Ivor Lewis esophagogastrectomy (ILE). PET/CT was performed prior to and after CRT. Patient/treatment characteristics and tumor response were analyzed. Results Over this timeframe, 16 patients completed trimodality therapy. All were male, median age of 60 years (45-72 years). All tumors were grade 2-3 with mean tumor length of 4.4 cm (1-9 cm). A median of 6 cycles (5-9 cycles) neoadjuvant carboplatin/paclitaxel were administered. Average time from diagnosis to CRT completion was 76 days (44-141 days) and 60 days (35-92 days) from CRT end to surgery. Neoadjuvant CRT was well tolerated with mean weight loss of 3.9 kg. All pts had R0 resections. No anastomotic leaks or perioperative mortality occurred. Mean hospital stay was 13 days (8-28 days). Pathologic complete response (pCR) was seen in 38% of patients, microscopic residual disease (isolated tumor cells or <2 mm) in 31%, and macroscopic residual disease remained in 31%. Mean SUV reduction was 41% (0-100%). Of 11 patients with ?35% SUV decrease, 45% had pCR and 27% had microscopic residual disease. Three patients had signet ring features. Of these, 2 had no SUV reduction and all had gross residual disease, including the only patient with positive nodal disease. Conclusions Trimodality therapy utilizing concurrent carboplatin/paclitaxel and radiotherapy to 50.4 Gy followed by surgery was well tolerated and resulted in significant pathologic complete response or minimal residual disease. Further investigation of predictive factors for response is needed to best tailor therapy in the management of esophageal/GEJ adenocarcinoma. PMID:23730509

Nurkin, Steven J.; Fong, Mei Ka; Groman, Adrienne; Flaherty, Leayn; Malhotra, Usha; LeVea, Charles M.; Yendamuri, Sai; Warren, Graham W.; Nava, Hector R.; May, Kilian S.

2013-01-01

345

Esophageal intraepithelial invasion of Helicobacter pylori correlates with atypical hyperplasia.  

PubMed

Helicobacter pylori (H. pylori), a common pathogen residing in the gastrointestinal tract, has been well characterized in stomach cancer,while its correlation with esophageal cancer remains poorly understood. In this study, we aim to assess the relationship between esophageal intraepithelial H. pylori invasion and inflammation as well as atypical hyperplasia in esophageal squamous epithelial tissues. Esophageal squamous cell carcinoma (ESCC) tissue samples from 196 individuals from both southern and northern esophageal carcinoma high-risk areas in China were examined (125 from northern high-risk areas, 71 from southern high-risk area), while additional 30 samples were collected adjacent to the esophageal squamous cell carcinoma (A-ESCC). H. pylori infection was identified by Giemsa staining, immuno-histochemical staining, and H. pylori 16S rRNA-based PCR. A significant increase of H. pylori infection was found in tumor tissues (including ESCC and A-ESCC samples) compared to that of non-tumor tissues (p?esophageal epithelial NE3 cells, suggesting that H. pylori infection may be an original cause leading to atypical hyperplasia of esophageal squamous epithelial tissues and contributed to pathological carcinogenesis of ESCC. PMID:24254881

Li, Wen-sheng; Tian, Dong-ping; Guan, Xiao-ying; Yun, Hailong; Wang, Hong-tao; Xiao, Yinping; Bi, Chao; Ying, Songmin; Su, Min

2014-06-01

346

Helicobacter pylori infection inhibits reflux esophagitis by inducing atrophic gastritis  

Microsoft Academic Search

OBJECTIVE:Although it is widely accepted that Helicobacter pylori (H. pylori) infection is an important cause of atrophic gastritis, few studies have examined the relationship between H. pylori-induced atrophic gastritis and the occurrence of reflux esophagitis. The present study was aimed to examine the relationship between H. pylori infection, atrophic gastritis, and reflux esophagitis in Japan.METHODS:A total of 175 patients with

Tomoyuki Koike; Shuichi Ohara; Hitoshi Sekine; Katsunori Iijima; Katsuaki Kato; Tooru Shimosegawa; Takayoshi Toyota

1999-01-01

347

[Efficacy of sorption therapy in patients with cicatricial esophageal stenosis].  

PubMed

We examined 110 patients treated conservatively for cicatricial esophageal stenosis including expansion on the string. The patients were divided into three groups: controls (n = 35), receiving adjuvant SUMS-1 (n = 38) and given adjuvant enterosgel (n = 37). According to electron microscopy, enterosorbents make esophageal mucosa denser by decreasing interstitial spaces as a result of microcirculatory improvement and reduction of edema. Enterosorbents elevate total protein and sugar in the blood. PMID:17002045

Chikinev, Iu V; Antonov, A R; Korobe?nikov, A V

2006-01-01

348

Outcome of histologically node-negative esophageal squamous cell carcinoma  

Microsoft Academic Search

The outcome of node-negative esophageal carcinoma and the prognostic significance of lymph node micrometastasis remain unknown.\\u000a The aim of this retrospective study was to clarify these two points. A series of 98 patients who underwent curative operation\\u000a for histologically node-negative (pNO in TNM classification) esophageal carcinoma were enrolled in the study. We reviewed\\u000a the cause of death of these patients.

Yoichi Tabira; Masahiro Yasunaga; Tomonori Sakaguchi; Yuji Yamaguchi; Toshiyuki Okuma; Michio Kawasuji

2002-01-01

349

Significance of duodenogastric reflux in patients with erosive esophagitis.  

PubMed

The role of duodenogastric reflux (DGR) in producing esophageal mucosal injury across the spectrum of GERD is still controversial. Our objective was to assess the role of DGR in the genesis and evolution of erosive esophagitis. Forty patients are presented who meet the criteria for the diagnosis of erosive esophagitis. Symptom scoring, endoscopy and mucosal biopsy with patohistologic classification of erosive esophagitis and a quantification of DGR, using scintigraphic imaging after intravenous injection of 99mTc-labeled HIDA, was performed. DGR was demonstrated in half of the patients. Both groups of patients (with and without DGR) were treated with life style changes, cisapride and nizatidine for a period of six weeks. After this period, symptom scoring, endoscopy and biopsy were performed again in both groups. There has been a significant decrease in the level of symptom scoring and endoscopic inflammation after the therapy, but without statistically significant difference between these two groups. Patohistologic finding after the medical treatment showed a marked difference between the two groups concerning the presence of DGR, indicating that the level of inflammation is statistically significantly higher in the group with DGR. This study showed that even if symptom scoring and endoscopy revealed improvement after the therapy in both groups of patients, patohistologic mucosal damage in patients with erosive esophagitis is greatly dependent of the presence of DGR. We conclude that alkaline component of GERD should be considered in the evaluation of patients with erosive esophagitis so that appropriate surgical therapy can be instituted. PMID:11432229

Simi?, A; Pesko, P

2000-01-01

350

Primary esophageal sclerosing mucoepidermoid carcinoma with “tissue eosinophilia”  

PubMed Central

Mucoepidermoid carcinoma (MEC) is a rare primary esophageal malignancy. It is characterized by poor clinical recognition, pre-operative diagnostic challenges and a lack of standardized therapeutic guidelines. We report the clinicopathological features of a hitherto unreported variant of esophageal MEC, sclerosing MEC with “tissue eosinophilia”, in a mid-esophageal location in a 51-year-old female. The diagnosis of the initial biopsy was challenging, because of the small size, poor orientation and inadequate representation of the MEC components. Recognition of the resectability of the tumor prompted surgical resection and enabled a demonstration of the low grade foci containing intermediate cells, mucin pools and the hitherto undescribed presence of stromal sclerosis and tissue eosinophils in esophageal MEC. Heightened clinicopathological awareness of esophageal MEC facilitated a definitive diagnosis and patient management. Increased recognition and global documentation of esophageal sclerosing MEC with “tissue eosinophilia” is necessary to improve the understanding and diagnosis of this malignancy in this location and to improve management guidelines. PMID:24944502

Mewa Kinoo, Suman; Maharaj, Kapil; Singh, Bhugwan; Govender, Michelle; Ramdial, Pratistadevi Kanaye

2014-01-01

351

Protective Effect of ECQ on Rat Reflux Esophagitis Model  

PubMed Central

This study was designed to determine the protective effect of Rumex Aquaticus Herba extracts containing quercetin-3-?-D-glucuronopyranoside (ECQ) on experimental reflux esophagitis. Reflux esophagitis was induced by surgical procedure. The rats were divided into seven groups, namely normal group, control group, ECQ (1, 3, 10, 30 mg/kg) group and omeprazole (30 mg/kg) group. ECQ and omeprazole groups received intraduodenal administration. The Rats were starved for 24 hours before the experiments, but were freely allowed to drink water. ECQ group attenuated the gross esophagitis significantly compared to that treated with omeprazole in a dose-dependent manner. ECQ decreased the volume of gastric juice and increased the gastric pH, which are similar to those of omeprazole group. In addition, ECQ inhibited the acid output effectively in reflux esophagitis. Significantly increased amounts of malondialdehyde (MDA), myeloperoxidase (MPO) activity and the mucosal depletion of reduced glutathione (GSH) were observed in the reflux esophagitis. ECQ administration attenuated the decrement of the GSH levels and affected the MDA levels and MPO activity. These results suggest that the ECQ has a protective effect which may be attributed to its multiple effects including anti-secretory, anti-oxidative and anti-inflammatory actions on reflux esophagitis in rats. PMID:23269908

Jang, Hyeon-Soon; Han, Jeong Hoon; Jeong, Jun Yeong

2012-01-01

352

Research advances in esophageal diseases: bench to bedside  

PubMed Central

Over the last year, significant steps have been made toward understanding the pathogenesis of esophageal diseases and translating this knowledge to clinical practice. Gastroesophageal reflux disease (GERD) is the most common outpatient diagnosis in gastroenterology and has a high prevalence in the general population. As many as 40% of patients with GERD have incomplete response to medical therapy, and the pathophysiological mechanisms underlying lack of response are now better understood. Novel medical and minimally invasive interventions are available to optimize management of GERD. Esophageal cancer, regardless of the histological subtype, has among the worst survival statistics among all malignancies. Taking advantage of technological advances in genome sequencing, the mutational spectra in esophageal cancer are now emerging, offering novel avenues for targeted therapies. Early diagnosis is another strand for improving survival. While genome-wide association studies are providing insights into genetic susceptibility, novel approaches to early detection of cancer are being devised through the use of biomarkers applied to esophageal samples and as part of imaging technologies. Dysmotility and eosinophilic esophagitis are the differential diagnoses in patients with dysphagia. New pathophysiological classifications have improved the management of motility disorders. Meanwhile, exciting progress has been made in the endoscopic management of these conditions. Eosinophilic esophagitis is still a relatively new entity, and the pathogenesis remains poorly understood. However, it is now clear that an allergic reaction to food plays an important role, and dietary interventions as well as biologic agents to block the inflammatory cascade are novel, promising fields of clinical research. PMID:24167725

di Pietro, Massimiliano

2013-01-01

353

Effect of bolus composition on esophageal transit: concise communication  

SciTech Connect

The technique of esophageal scintigraphy was developed as a sensitive, quantitative, noninvasive test of esophageal transit. Esophageal scintigraphy was performed in 40 asymptomatic normal volunteers in order to determine the effect on esophageal transit of the following: body posture (sitting vs. supine), liquid vs. solid, the solid being either a standard number4 gelatin capsule of the size used for antibiotic capsules, or a cube of solid food such as cooked chicken liver. The results showed that liquids emptied completely from the esophagus after one swallow, whether supine or sitting. Capsules or liver cubes, when ingested without water, frequently remained in the esophagus for up to two hours without the subject's having any sensation that the solid had not left the esophagus. Both capsules and liver cubes cleared the esophagus better in the upright than in the supine position. When gelatin capsules were swallowed with as little as 15 ml of water, but after a preliminary sip of water, there was complete transit in each case. The study suggests that the practice of assisting patients into a sitting position and instructing them to take a sip of water before attempting to swallow a capsule will assure better transit of the capsule even when swallowed with as little as 15 ml of water. This may reduce the incidence of esophagitis following oral antibiotics, and of esophageal erosions from aspirin-containing medications.

Fisher, R.S.; Malmud, L.S.; Applegate, G.; Rock, E.; Lorber, S.H.

1982-10-01

354

Effect of bolus composition on esophageal transit: concise communication  

SciTech Connect

The technique of esophageal scintigraphy was developed as a sensitive, quantitative, noninvasive test of esophageal transit. Esophageal scintigraphy was performed in 40 asymptomatic normal volunteers in order to determine the effect on esophageal transit of the following: body posture (sitting vs. supine), liquid vs. solid, the solid being either a standard gelatin capsule of the size used for antibiotic capsules, or a cube of solid food such as cooked chicken liver. The results showed that liquids emptied completely from the esophagus after one swallow whether supine or sitting. Capsules or liver cubes, when ingested without water, frequently remained in the esophagus for up to two hours without the subject's having any sensation that the solid had not left the esophagus. Both capsules and liver cubes cleared the esophagus better in the upright than in the supine position. When gelatin capsules were swallowed with as little as 15 ml of water, but after a preliminary sip of water, there was complete transit in each case. The study suggests that the practice of assisting patients into a sitting position and instructing them to take a sip of water before attempting to swallow a capsule will assure better transit of the capsule even when swallowed with as little as 15 ml of water. This may reduce the incidence of esophagitis following oral antibiotics, and of esophageal erosions from aspirin-containing medications.

Fisher, R.S.; Malmud, L.S.; Appelgate, G.; Rock, E.; Lorber, S.H.

1982-10-01

355

Survival Effect of Neoadjuvant Radiotherapy Before Esophagectomy for Patients With Esophageal Cancer: A Surveillance, Epidemiology, and End-Results Study  

SciTech Connect

Purpose: The role of neoadjuvant radiotherapy (NeoRT) before definitive surgery for esophageal cancer remains controversial. This study used a large population-based database to assess the effect of NeoRT on survival for patients treated with definitive surgery. Methods and Materials: The overall survival (OS) and cause-specific survival for patients with Stage T2-T4, any N, M0 (cT2-T4M0) esophageal cancer who had undergone definitive surgery between 1998 and 2004 were analyzed by querying the Surveillance, Epidemiology, and End-Results database. Kaplan-Meier survival curves were generated and univariate comparisons were made using the log-rank test. Cox proportional hazards survival regression multivariate analysis was performed with NeoRT, T stage (T2 vs. T3-T4), pathologic nodal status (pN0 vs. pN1), number of nodes dissected (>10 vs. {<=}10), histologic type (adenocarcinoma vs. squamous cell carcinoma), age (<65 vs. {>=}65 years), and gender as covariates. Results: A total of 1,033 patients were identified. Of these, 441 patients received NeoRT and 592 underwent esophagectomy alone; 77% were men, 67% had adenocarcinoma, and 72% had Stage T3-T4 disease. The median OS and cause-specific survival were both significantly greater for patients who received NeoRT compared with esophagectomy alone (27 vs. 18 months and 35 vs. 21 months, respectively, p <0.0001). The 3-year OS rate was also significantly greater in the NeoRT group (43% vs. 30%). On multivariate analysis, NeoRT, age <65 years, adenocarcinoma histologic type, female gender, pN0 status, >10 nodes dissected, and Stage T2 disease were all independently correlated with increased OS. Conclusion: These results support the use of NeoRT for patients with esophageal cancer. Prospective studies are needed to confirm these results.

Schwer, Amanda L. [Department of Radiation Oncology, University of Colorado Health Sciences Center, Aurora, Colorado (United States)], E-mail: amanda.schwer@uchsc.edu; Ballonoff, Ari; McCammon, Robert; Rusthoven, Kyle [Department of Radiation Oncology, University of Colorado Health Sciences Center, Aurora, Colorado (United States); D'Agostino, Ralph B. [Department of Biostatistical Science, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Schefter, Tracey E. [Department of Radiation Oncology, University of Colorado Health Sciences Center, Aurora, Colorado (United States)

2009-02-01

356

Fluorescence spectroscopy for diagnosis of esophageal cancer  

NASA Astrophysics Data System (ADS)

Laser-induced fluorescence spectroscopy was employed to measure fluorescence emission of normal and malignant tissue during endoscopy in patients with esophageal adenocarcinoma. A nitrogen/dye laser tuned at 410 nm was used for excitation source. The fluorescence lineshape of each spectrum was determined and sampled at 15 nm intervals from 430 nm to 716 nm. A calibration set from normal and malignant spectra were selected. Using stepwise discriminate analysis, significant wavelengths that separated normal and malignant spectra were selected. The intensities at these wavelengths were used to formulate a classification model using linear discriminate analysis. The model was used to classify additional tissue spectra from 26 malignant and 108 normal sites into either normal or malignant spectra with a sensitivity of 100 percent and specificity of 98 percent.

Panjehpour, Masoud; Overholt, Bergein F.; Vo-Dinh, Tuan; Farris, Christie; Schmidhammer, James L.; Sneed, Rick E.; Buckley, Paul F., III

1994-07-01

357

Bacteremia after injection of esophageal varices.  

PubMed

Elective sclerotherapy for esophageal varices produces bacteremia in 4% to 53% of patients. The clinical importance of this phenomenon is uncertain. This study was undertaken to re-assess the incidence and clinical relevance of post-sclerotherapy bacteremia. Blood cultures were taken prior to and at 5 min and 4 h after endoscopy in 50 patients for whom sclerotherapy was planned. In the 41 patients in whom varices were injected, positive cultures were obtained 5 min after sclerotherapy in only 4 patients (10%) and all but 1 patient had other possible causes of bacteremia. After 4 h, all blood cultures were sterile. No infective complications were identified. Bacteremia appears to be an infrequent and transient event after elective sclerotherapy. Only patients with prosthetic heart valves or endocardial abnormalities require antibiotic prophylaxis. PMID:2315821

Lorgat, F; Madden, M V; Kew, G; Roditi, D; Krige, J E; Bornman, P C; Jonker, M A; Terblanche, J

1990-01-01

358

Factors affecting long-term survival in elderly patients undergoing radiotherapy for esophageal carcinoma  

PubMed Central

This study was conducted with the aim to analyze the factors affecting the 1-, 3- and 5-year survival rate of elderly patients with esophageal carcinoma. Between 2004 and 2008, a total of 371 patients aged ?70 years treated with radiotherapy alone were enrolled in this study. The clinical characteristics and radiotherapy dose were evaluated by survival rate and the 1-, 3- and 5-year overall survival (OS) rates were found to be 42, 13.2 and 9.16%, respectively. The univariate analysis revealed significant differences in T, N, M and clinical stage and radiotherapy dose (all P-values <0.05) and no significant differences in gender (all P-values >0.05). There was a difference in tumor location when only comparing the 3- and 5-year OS rates (P=0.031 and P=0.025, respectively). The multivariate analysis identified clinical stage as an independent factor for the 1-year OS rate (P=0.003), whereas radiotherapy dose and clinical stage were found to be independent factors for the 3- and 5-year OS rates (all P-values 0.05). In the analysis of radiotherapy dose, we observed no significant difference in the 1-year OS rate between the radiation dose (DT) >60 Gy and the 50 Gy?DT<60 Gy groups (P=0.363); however, there were statistically significant differences in the 3-year OS rate between the 50 Gy?DT<60 Gy and the other groups (P=0.039 and P=0.032); there were no significant differences in the 5-year OS rate among the dose groups (all P-values >0.05). In conclusion, according to the findings of this retrospective study, radiotherapy alone for elderly patients with esophageal cancer does not appear to be acceptable and there is a need for a more effective treatment. T, N, M and clinical stage and radiotherapy dose were identified as factors significantly affecting the 1-, 3- and 5-year OS in elderly patients with esophageal carcinoma, although a higher radiotherapy dose with normal fractionation did not appear to improve the OS rate. PMID:24940497

LU, XIAOXU; WU, HUI; WANG, JIANHUA; CHEN, YONGSHUN; XU, JING

2014-01-01

359

Video-thoracoscopic enucleation of esophageal leiomyoma  

PubMed Central

Background Leiomyoma is the most common benign tumor of the esophagus. Surgical enucleation is indicated in case of symptoms or an unclear diagnosis, and open thoracotomy has long been the standard approach for this procedure. However, enucleation through video assisted thoracoscopic surgery (VATS) has been developed as a preferred approach for most lesions in recent years. Method Herein we report our twelve patients (seven men and five women, with median age of 42 years) from 2001 to 2009, who underwent enucleation through VATS for esophageal leiomyomas, with a size from 1 to 8 cm in diameter (median: 5), and at different locations, from the thoracic outlet to near the diaphragmatic level of the thoracic esophagus. Intraoperative fiberoptic esophagoscopy was performed in two patients for localization by illumination. A right-sided approach was performed in eight cases (upper two thirds of esophagus) and the left-sided in another four cases (lower third of esophagus). Result The median operative time was 95 minutes (70 to 230 minutes). Four of them required small utility incisions (4-6 cm) for better exploration and manipulation. There were no major complications, such as death or empyema due to leaks from mucosal tears, and the presenting symptoms were improved during the follow-up period, from 12 to 98 months. Conclusion VATS can be considered as an initial approach for most patients with esophageal leiomyomas, even large in size, irregular in shape, or at unfavorable location. It is a safe, minimally invasive, and effective treatment. However, conversion to open thoracotomy should be required for the sake of clinical or technical concern. PMID:22420503

2012-01-01

360

Unprecedented structural variations in trinuclear mixed valence Co(ii/iii) complexes: theoretical studies, pnicogen bonding interactions and catecholase-like activities.  

PubMed

Three new mixed valence trinuclear Co(ii/iii) compounds cis-[Co3L2(MeOH)2(N3)2(?1,1-N3)2] (), trans-[Co3L2(H2O)2(N3)2(?1,1-N3)2]·(H2O)2 () and [Co3L(R)2(N3)3(?1,3-N3)] () have been synthesized by reacting a di-Schiff base ligand () or its reduced form [] (where = N,N'-bis(salicylidene)-1,3-propanediamine and = N,N'-bis(2-hydroxybenzyl)-1,3-propanediamine) with cobalt perchlorate hexahydrate and sodium azide. All three products have been characterized by IR, UV-Vis and EPR spectroscopies, ESI-MS, elemental, powder and single crystal X-ray diffraction analyses. Complex is an angular trinuclear species in which two terminal octahedral Co(iii)N2O4 centers coordinate to the central octahedral cobalt(ii) ion through ?2-phenoxido oxygen and ?1,1-azido nitrogen atoms along with two mutually cis-oxygen atoms of methanol molecules. On the other hand, in linear trinuclear complex , in addition to the ?2-phenoxido and ?1,1-azido bridges with terminal octahedral Co(iii) centres, the central Co(ii) is bonded with two mutually trans-oxygen atoms of water molecules. Thus the cis-trans configuration of the central Co(ii) is solvent dependent. In complex , the two terminal octahedral Co(iii)N2O4 centers coordinate to the central penta-coordinated Co(ii) ion through double phenoxido bridges along with the nitrogen atom of a terminal azido ligand. In addition, the two terminal Co(iii) are connected through a ?1,3-azido bridge that participates in pnicogen bonding interactions (intermolecular N-N interaction) as an acceptor. Both the cis and trans isomeric forms of and have been optimized using density functional theory (DFT) calculations and it is found that the cis configuration is energetically more favorable than the trans one. However, the trans configuration of is stabilized by the hydrogen bonding network involving a water dimer. The pnicogen bonding interactions have been demonstrated using MEP surfaces and CSD search which support the counter intuitive electron acceptor ability of the ?1,3-azido ligand. Complexes exhibit catecholase-like activities in the aerial oxidation of 3,5-di-tert-butylcatechol to the corresponding o-quinone. Kinetic data analyses of this oxidation reaction in acetonitrile reveal that the catecholase-like activity follows the order: (kcat = 142 h(-1)) > (kcat = 99 h(-1)) > (kcat = 85 h(-1)). Mechanistic investigations of the catalytic behaviors by X-band EPR spectroscopy and estimation of hydrogen peroxide formation indicate that the oxidation reaction proceeds through the reduction of Co(iii) to Co(ii). PMID:25611163

Hazari, Alokesh; Kanta Das, Lakshmi; Kadam, Ramakant M; Bauzá, Antonio; Frontera, Antonio; Ghosh, Ashutosh

2015-02-10

361

Chyluria after ligation of the thoracic duct: a rare complication after thoracoscopic-assisted esophagectomy for esophageal cancer.  

PubMed

Chyluria is leakage of lymphatic fluid into the urine, following trauma to or obstruction of the lymphatic system. We herein report a rare case of chyluria after esophagectomy for esophageal cancer. A 69-year-old male complaining of epigastric pain and reflux symptoms was diagnosed with advanced esophageal cancer and regional lymph node metastases. After receiving neoadjuvant chemotherapy to control the regional lymph node metastases, the patient underwent transthoracic excision of the esophagus assisted by thoracoscopy, with excision of the azygos vein and thoracic duct, esophagostomy and tube gastrostomy. On postoperative day 22, the urine appeared ivory white in color, and urine tests showed a high triglyceride level, thus confirming the diagnosis of chyluria. The chyluria decreased temporarily after switching the patient from enteral nutrition (EN) to parental nutrition, but it emerged again after the resumption of EN. Lymphangiography at that stage showed the flow of lipiodol into the pelvis of the left kidney. Resolution of the chyluria was noted after lymphangiography. He underwent esophageal reconstruction with a gastric tube through an anterior mediastinal route, and was discharged 36 days after the second operation. He was thereafter followed up at the outpatient clinic with radiotherapy. PMID:23229840

Takeno, Atsushi; Tamura, Shigeyuki; Miki, Hirofumi; Tanigawa, Noboru; Taniguchi, Hirokazu; Nakahira, Shin; Suzuki, Rei; Nakata, Ken; Takeda, Yutaka; Kato, Takeshi

2014-04-01

362

A Phase II/III study comparing carboplatin and irinotecan with carboplatin and etoposide for the treatment of elderly patients with extensive-disease small-cell lung cancer (JCOG1201).  

PubMed

A randomized Phase II/III trial commenced in Japan in December 2013. Carboplatin plus etoposide is the current standard treatment for elderly extensive-disease small-cell lung cancer. The purpose of this study is to confirm the superiority of carboplatin plus irinotecan in terms of overall survival over carboplatin plus etoposide for elderly extensive-disease small-cell lung cancer patients in a Phase II/III design. A total of 370 patients will be accrued from 38 Japanese institutions within 5 years. In the Phase II part, the primary endpoint is the response rate of the carboplatin plus irinotecan arm and the secondary endpoint is adverse events. In the Phase III part, the primary endpoint is overall survival and the secondary endpoints are progression-free survival, response rate, adverse events, serious adverse events and symptom score. This trial has been registered at the UMIN Clinical Trials Registry as UMIN000012605 (http://www.umin.ac.jp/ctr/index.htm). PMID:25332420

Eba, Junko; Shimokawa, Tsuneo; Nakamura, Kenichi; Shibata, Taro; Misumi, Yuki; Okamoto, Hiroaki; Yamamoto, Noboru; Ohe, Yuichiro

2015-01-01

363

Clinical esophageal pH recording: A technical review for practice guideline development  

Microsoft Academic Search

Our present concept of peptic esophagitis dates back to 1935, when Winkelstein suggested that gastric secretions were the cause of mucosal damage observed in peptic esophagitis.1GASTROENTEROLOGY 1996;110-1982-1996

Peter J Kahrilas; Eamonn M. M Quigley

1996-01-01

364

Treatment of esophageal stricture due to lichen planus with intralesional corticosteroid injection.  

PubMed

Herein we presented a male patient with esophageal stricture due to lichen planus successfully treated with repeated injections of intralesional triamcinolone and review the current literature on esophageal lichen planus with special emphasis on its treatment. PMID:24487173

Köksal, Aydin S; Yildiz, Hakan; Odemi?, Bülent; Sengül, Ay?egül

2014-02-01

365

Omental mesothelial cyst herniated to the thorax through the esophageal hiatus: a case report.  

PubMed

Both mesothelial cyst in the omentum and omental herniation through the esophageal hiatus without abdominal visceral involvement are rare. We report a case of omental mesothelial cyst herniated to the thorax through the esophageal hiatus. PMID:20871418

Lee, Eun Ju; Choi, Yo Won; Jeon, Seok Chol; Heo, Jeong-Nam; Park, Choong Ki; Paik, Seung Sam; Chung, Won Sang

2011-08-01

366

TGM2 A Cell Surface Marker in Esophageal Adenocarcinomas  

PubMed Central

Introduction Esophageal adenocarcinomas (EAC) are aggressive cancers that are increasing in incidence and associated with a poor prognosis. The identification of highly expressed genes in EAC relative to metaplastic Barrett’s esophagus (BE) may provide new targets for novel early cancer detection strategies using endoscopically administered, fluorescently labeled peptides. Methods Gene expression analysis of BE and EACs were used to identify the cell surface marker transglutaminase 2 (TGM2) as overexpressed in cancer. The expression of two major isoforms of TGM2 was determined by qRT-polymerase chain reaction in an independent cohort of 128 EACs. Protein expression was confirmed by tissue microarrays and immunoblot analysis of EAC cell lines. TGM2 DNA copy number was assessed using single nucleotide polymorphism microarrays and confirmed by qPCR. TGM2 expression in neoadjuvantly treated EACs and following small interfering RNA-mediated knockdown in cisplatin-treated EAC cells was used to determine its possible role in chemoresistance. Results TGM2 is overexpressed in 15 EACs relative to 26 BE samples. Overexpression of both TGM2 isoforms was confirmed in 128 EACs and associated with higher tumor stage, poor differentiation, and increased inflammatory and desmoplastic response. Tissue microarrays and immunohistochemistry confirmed elevated TGM2 protein expression in EAC. Single nucleotide polymorphism and qPCR analysis revealed increased TGM2 gene copy number as one mechanism underlying elevated TGM2 expression. TGM2 was highly expressed in resistant EAC after patient treatment with neoadjuvant chemotherapy/radiation suggesting a role for TGM2 in chemoresistance. Conclusion TGM2 may be a useful cell surface biomarker for early detection of EAC. PMID:24828664

Leicht, Deborah T.; Kausar, Tasneem; Wang, Zhuwen; Ferrer-Torres, Daysha; Wang, Thomas D.; Thomas, Dafydd G.; Lin, Jules; Chang, Andrew C.; Lin, Lin; Beer, David G.

2014-01-01

367

Indications, technique, and clinical use of ambulatory 24-hour esophageal motility monitoring in a surgical practice.  

PubMed Central

The development of miniaturized electronic pressure transducers and portable digital data recorders with large storage capacity has made ambulatory monitoring of esophageal motor function over an entire circadian cycle possible. The broad clinical application of this new technology in a large number of asymptomatic normal volunteers and patients with primary esophageal motor disorders or gastroesophageal reflux disease provides new insights into esophageal motor function in health and disease under a variety of physiologic conditions. In normal volunteers and symptomatic patients, esophageal motor activity increases with both the state of consciousness and eating activity, i.e., from sleep to awake to meal periods. In the normal situation there is a higher prevalence of nonperistaltic esophageal contractions than appreciated on stationary manometry. Compared with standard manometry, ambulatory esophageal manometry provides a more than 100-fold larger database for the classification and quantitation of abnormal esophageal motor function and leads to a change in the diagnosis in a substantial portion of patients with symptoms suggestive of a primary esophageal motor disorder. In patients with nonobstructive dysphagia, the circadian esophageal motility pattern is characterized by an inability to organize the motor activity into peristaltic contractions during meal periods. In patients with noncardiac chest pain, ambulatory motility monitoring can document a direct correlation of abnormal esophageal motor activity with the symptom and shows that the abnormal motor activity immediately preceding the pain episodes is characterized by an increased frequency of simultaneous, double- and triple-peaked, high-amplitude, and long-duration contractions. A long esophageal myotomy can abolish the ability of the esophagus to produce this abnormal motor pattern. In patients with gastroesophageal reflux disease, ambulatory motility monitoring shows that the contractility of the esophageal body deteriorates with increasing severity of esophageal mucosal injury, compromising the clearance function of the esophageal body. These data suggest that ambulatory esophageal motility monitoring allows for a more precise classification of esophageal motor disorders than standard manometry and can identify abnormal esophageal motor pattern associated with nonobstructive dysphagia, noncardiac chest pain, or gastroesophageal reflux. Ambulatory esophageal manometry therefore should replace standard manometry in the assessment of esophageal body function and has potential to improve the diagnosis and management of patients with esophageal motor abnormalities. The combination of ambulatory 24-hour esophageal manometry with esophageal and gastric pH monitoring is currently the most physiologic way to assess patients with functional foregut disorders. PMID:8439211

Stein, H J; DeMeester, T R

1993-01-01

368

Overexpression of FXYD-3 Is Involved in the Tumorigenesis and Development of Esophageal Squamous Cell Carcinoma  

PubMed Central

Objective. To investigate the association of FXYD-3 expression with clinicopathological variables and PINCH in patients with ESCC. Patients and Methods. Expression of FXYD-3 protein was immunohistochemically examined in normal esophageal mucous (n = 20) and ESCC (n = 64). Results. Expression of FXYD-3 in the cytoplasm markedly increased from normal esophageal epithelial cells to primary ESCC (P = 0.001). The expression of FXYD-3 was correlated with TNM stages and depth of tumor invasion. Furthermore, the cases with lymph node metastasis tended to show a higher frequency of positive expression than those without metastasis (P = 0.086), and FXYD-3 expression tended to be positively related to the expression of PINCH (P = 0.063). Moreover, the cases positive for both proteins had the highest frequency of lymph node metastasis (P = 0.001). However, FXYD-3 expression was not correlated with patient's gender (P = 0.847), age (P = 0.876), tumor location (P = 0.279), size (P = 0.771), grade of differentiation (P = 0.279), and survival (P = 0.113). Conclusion. Overexpression of FXYD-3 in the cytoplasm may play an important role in the tumorigenesis and development in the human ESCC, particularly in combination with PINCH expression. PMID:24167366

Zhu, Zhen-Long; Yan, Bao-Yong; Yang, Yan-Hong; Wang, Ming-Wei; Zentgraf, Hanswalter; Zhang, Xiang-Hong; Sun, Xiao-Feng

2013-01-01

369

Expression of YY1 correlates with progression and metastasis in esophageal squamous cell carcinomas  

PubMed Central

Objective Esophageal squamous cell carcinoma (ESCC) is one of the deadliest cancers worldwide. Yin Yang 1 (YY1) is a ubiquitous and multifunctional zinc-finger transcription factor that plays important biological functions in cell homeostasis and tumorigenesis. The purpose of this study was to investigate the expression of YY1 in different ESCC tissues and the potential relationship with clinicopathological features. Methods One hundred and four ESCC tissues were collected in this study. The protein levels of YY1 were measured by immunohistochemistry. TE-1 cell invasion in vitro was assessed using the Transwell assay. Results There were no obvious differences between expression levels in patients over age 64 and those younger than 64, and no noticeable distinction was observed between males and females. However, the YY1 protein level was significantly higher in ESCC tissues with lymph node metastasis than those without lymph node metastasis (P=0.042). Furthermore, the expression of the YY1 protein was stronger in stage III–IV patients than in stage I–II patients (P=0.002), but the protein levels between different histological grades (well, moderate, or poor) showed no statistical significance. Similarly, there was no difference in YY1 expression in patients with or without lymphatic invasion. The Transwell assay revealed that the overexpression of YY1 promoted the invasion ability of TE-1 cells and the inhibition of YY1 could reverse this promotion. Conclusion YY1 expression was associated with TNM stage and lymph node metastasis, suggesting that YY1 can influence human esophageal cancer progression and metastasis. PMID:25328408

Luo, Judong; Jiang, Xin; Cao, LiLi; Dai, Kejun; Zhang, Shuyu; Ge, Xin; Zhou, Xifa; Lu, Xujing

2014-01-01

370

MMP-1/PAR-1 signal transduction axis and its prognostic impact in esophageal squamous cell carcinoma  

PubMed Central

The matrix metalloprotease-1 (MMP-1)/protease-activated receptor-1 (PAR-1) signal transduction axis plays an important role in tumorigenesis. To explore the expression and prognostic value of MMP-1 and PAR-1 in esophageal squamous cell carcinoma (ESCC), we evaluated the expression of two proteins in resected specimens from 85 patients with ESCC by immunohistochemistry. Sixty-two (72.9%) and 58 (68.2%) tumors were MMP-1- and PAR-1-positive, respectively, while no significant staining was observed in normal esophageal squamous epithelium. MMP-1 and PAR-1 overexpression was significantly associated with tumor node metastasis (TNM) stage and regional lymph node involvement. Patients with MMP-1- and PAR-1-positive tumors, respectively, had poorer disease-free survival (DFS) than those with negative ESCC (P = 0.002 and 0.003, respectively). Univariate analysis showed a significant relationship between TNM stage [hazard ratio (HR) = 2.836, 95% confidence interval (CI) = 1.866-4.308], regional lymph node involvement (HR = 2.955, 95%CI = 1.713-5.068), MMP-1 expression (HR = 2.669, 95%CI = 1.229-6.127), and PAR-1 expression (HR = 1.762, 95%CI = 1.156-2.883) and DFS. Multivariate analysis including the above four parameters identified TNM stage (HR = 2.035, 95%CI = 1.167-3.681), MMP-1 expression (HR = 2.109, 95%CI = 1.293-3.279), and PAR-1 expression (HR = 1.967, 95%CI = 1.256-2.881) as independent and significant prognostic factors for DFS. Our data suggest for the first time that MMP-1 and PAR-1 were both overexpressed in ESCC and are novel predictors of poor patient prognosis after curative resection. The MMP-1/PAR-1 signal transduction axis might be a new therapeutic target for future therapies tailored against ESCC. PMID:22086466

Peng, Hong-hua; Zhang, Xi; Cao, Pei-guo

2011-01-01

371

Increasing toxicity during neoadjuvant radiochemotherapy as positive prognostic factor for patients with esophageal carcinoma.  

PubMed

The aim of this study was to correlate acute organ toxicity during preoperative radiochemotherapy with overall survival and tumor regression for patients with primarily operable esophageal carcinoma. From 1995 to 2002, 60 patients with primarily operable esophageal carcinoma were treated in a preoperative setting at our department. Thirty-three percent of the patients had International Union against Cancer (UICC)-stage II tumors, 62% had UICC-stage III tumors, and 5% had UICC-stage IVA tumors. All patients received irradiation (40?Gy at 2?Gy/fraction). Chemotherapy for all patients with adenocarcinoma and, from 2001, also for patients with squamous cell carcinoma consisted of two cycles, 5-fluorouracil and cisplatinum; between 1995 and 2001, patients with squamous cell carcinoma received three courses of chemotherapy (folinic acid, etoposide, 5-fluorouracil, and cisplatinum every 3 weeks) before and further cisplatinum and etoposide during radiotherapy. We found a significant correlation between acute organ toxicity and histopathological tumor regression, as well as overall survival. The probability to achieve tumor regression grade 1 after radiochemotherapy was nearly four times higher for patients with worsening of odynophagia than for those without an increase (odds ratio: 3.97). Patients with worsening of odynophagia had a 5-year overall-survival rate of 66% compared with 39% in patients without (P = 0.048). Our data indicate that normal tissue and tumor tissue may behave similar with respect to treatment response, as acute organ toxicity showed to be an independent prognostic marker in our patient population. The hypothesis should be further analyzed on biomolecular and clinical level in future clinical trials. PMID:23574528

Hennies, S; Hermann, R M; Gaedcke, J; Grade, M; Hess, C F; Christiansen, H; Wolff, H A

2014-01-01

372

Thoracic Discitis as a Complication of Self-Expanding Metallic Stents in Esophageal Carcinoma  

SciTech Connect

The role of metallic stents in the palliation of esophageal cancer is well established. Self-expanding metal stents (SEMSs) are frequently used, as they provide an effective and safe method of relieving malignant dysphagia. A number of complications are associated with the use of SEMSs, including esophageal perforation. We report a case of thoracic discitis occurring in a patient with advanced esophageal malignancy, treated with SEMSs. We propose that the likely etiology in this patient was esophageal perforation by a metallic stent.

McQueen, A. S.; Eljabu, W.; Latimer, J., E-mail: joanne.latimer@nth.nhs.uk; Raju, P. P. J. [University Hospital of North Tees, Department of Radiology (United Kingdom)

2011-02-15

373

Esophageal reflexes modulate frontoparietal response in neonates: Novel application of concurrent NIRS and provocative esophageal manometry.  

PubMed

Central and peripheral neural regulation of swallowing and aerodigestive reflexes is unclear in human neonates. Functional near infrared spectroscopy (NIRS) is a noninvasive method to measure changes in oxyhemoglobin (HbO) and deoxyhemoglobin (HbD). Pharyngoesophageal manometry permits evaluation of aerodigestive reflexes. Modalities were combined to investigate feasibility and to test neonatal frontoparietal cortical changes during pharyngoesophageal (visceral) stimulation and/or swallowing. Ten neonates (45.6 ± 3.0 wk postmenstrual age, 4.1 ± 0.5 kg) underwent novel pharyngoesophageal manometry concurrent with NIRS. To examine esophagus-brain interactions, we analyzed cortical hemodynamic response (HDR) latency and durations during aerodigestive provocation and esophageal reflexes. Data are presented as means ± SE or percent. HDR rates were 8.84 times more likely with basal spontaneous deglutition compared with sham stimuli (P = 0.004). Of 182 visceral stimuli, 95% were analyzable for esophageal responses, 38% for HDR, and 36% for both. Of analyzable HDR (n = 70): 1) HbO concentration (?mol/l) baseline 1.5 ± 0.7 vs. 3.7 ± 0.7 poststimulus was significant (P = 0.02), 2) HbD concentration (?mol/l) between baseline 0.1 ± 0.4 vs. poststimulus -0.5 ± 0.4 was not significant (P = 0.73), and 3) hemispheric lateralization was 21% left only, 29% right only, and 50% bilateral. During concurrent esophageal and NIRS responses (n = 66): 1) peristaltic reflexes were present in 74% and HDR in 61% and 2) HDR was 4.75 times more likely with deglutition reflex vs. secondary peristaltic reflex (P = 0.016). Concurrent NIRS with visceral stimulation is feasible in neonates, and frontoparietal cortical activation is recognized. Deglutition contrasting with secondary peristalsis is related to cortical activation, thus implicating higher hierarchical aerodigestive protective functional neural networks. PMID:24789204

Jadcherla, Sudarshan R; Pakiraih, Joanna F; Hasenstab, Kathryn A; Dar, Irfaan; Gao, Xiaoyu; Bates, D Gregory; Kashou, Nasser H

2014-07-01

374

The endoscopic assessment of esophagitis: A progress report on observer agreement  

Microsoft Academic Search

BACKGROUND & AIMS: The study and management of reflux esophagitis require an endoscopic classification system founded on esophageal lesions that can be reproducibly identified. The aim of this study was to investigate interobserver agreement for the identification of endoscopic lesions typical of reflux esophagitis. METHODS: Paired comparisons of observers' descriptions were obtained. Seventeen endoscopists assessed 100 still images, and 42

D Armstrong; JR Bennett; AL Blum; J Dent; FT De Dombal; JP Galmiche; L Lundell; M Margulies; JE Richter; SJ Spechler; GN Tytgat; L Wallin

1996-01-01

375

Esophageal dysfunction in diabetes mellitus: is there a relation to clinical manifestation of neuropathy?  

Microsoft Academic Search

In a prospective study, we evaluated 33 diabetic patients [type I (n = 8) and type II (n = 25)]. Esophageal motor functions were examined by registering clinical symptoms and by performing esophageal manometry. We also investigated peripheral and autonomic neuropathy. In diabetics, the lower and upper esophageal sphincter pressure and amplitudes of peristaltic waves were reduced. Compared with controls

D. Hiippe; M. Tegenthoff; J. Faig; F. Brunke; S. Depka; M. Stuhldreier; G. Micklefield; A. Gillissen; B. May

1992-01-01

376

Oral trypsin inhibitor can improve reflux esophagitis after distal gastrectomy concomitant with decreased trypsin activity  

Microsoft Academic Search

BackgroundThe pathogenesis of reflux esophagitis is not well understood and remains controversial. Distal gastrectomy serves as a model to assess the role of duodenal reflux with low gastric acidity in the development of reflux esophagitis. We investigated the clinical usefulness and antitrypsin activity after treatment with a trypsin inhibitor, camostat mesilate, against the reflux esophagitis after distal gastrectomy reconstructed with

Koji Kono; Akihiro Takahashi; Hidemitsu Sugai; Toshiyoshi Umekawa; Tomoko Yano; Komei Kamiyasu; Makoto Teramatsu; Hideki Fujii

2005-01-01

377

Proton Beam Therapy with High-Dose Irradiation for Superficial and Advanced Esophageal Carcinomas1  

Microsoft Academic Search

Purpose: With the aim of improving the results of treat- ment for esophageal carcinoma, we have investigated the efficacy and toxicity associated with the use of a 250-MeV proton beam for radical radiation therapy in esophageal carcinoma. Experimental Design: Thirty patients with esophageal carcinoma (superficial, n 13; advanced, n 17) had been treated with proton beam therapy alone or with

Shohei Koyama; Hirohiko Tsujii

2003-01-01

378

Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux.  

PubMed Central

The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and various degrees of mucosal injury (no mucosal injury, n = 92; esophagitis, n = 66; stricture, n = 19; Barrett's esophagus, n = 28). Manometry and 24-hour esophageal pH monitoring showed that the prevalence and severity of esophageal mucosal injury was higher in patients with a mechanically defective lower esophageal sphincter (p less than 0.01) or increased esophageal acid/alkaline exposure (p less than 0.01) as compared with those with a normal sphincter or only increased esophageal acid exposure. Complications of GERD were particularly frequent and severe in patients who had a combination of a defective sphincter and increased esophageal acid/alkaline exposure (p less than 0.01). Combined esophageal and gastric pH monitoring showed that esophageal alkaline exposure was increased only in GERD patients with DGR (p less than 0.05) and that DGR was more frequent in GERD patients with a stricture or Barrett's esophagus. A mechanically defective lower esophageal sphincter and reflux of acid gastric juice contaminated with duodenal contents therefore appear to be the most important determinants for the development of mucosal injury in GERD. This explains why some patients fail medical therapy and supports the surgical reconstruction of the defective sphincter as the most effective therapy. PMID:1632700

Stein, H J; Barlow, A P; DeMeester, T R; Hinder, R A

1992-01-01

379

Volumetric modulated arc radiotherapy for esophageal cancer  

SciTech Connect

A treatment planning study was performed to evaluate the performance of volumetric arc modulation with RapidArc (RA) against 3D conformal radiation therapy (3D-CRT) and conventional intensity-modulated radiation therapy (IMRT) techniques for esophageal cancer. Computed tomgraphy scans of 10 patients were included in the study. 3D-CRT, 4-field IMRT, and single-arc and double-arc RA plans were generated with the aim to spare organs at risk (OAR) and healthy tissue while enforcing highly conformal target coverage. The planning objective was to deliver 54 Gy to the planning target volume (PTV) in 30 fractions. Plans were evaluated based on target conformity and dose-volume histograms of organs at risk (lung, spinal cord, and heart). The monitor unit (MU) and treatment delivery time were also evaluated to measure the treatment efficiency. The IMRT plan improves target conformity and spares OAR when compared with 3D-CRT. Target conformity improved with RA plans compared with IMRT. The mean lung dose was similar in all techniques. However, RA plans showed a reduction in the volume of the lung irradiated at V{sub 20Gy} and V{sub 30Gy} dose levels (range, 4.62-17.98%) compared with IMRT plans. The mean dose and D{sub 35%} of heart for the RA plans were better than the IMRT by 0.5-5.8%. Mean V{sub 10Gy} and integral dose to healthy tissue were almost similar in all techniques. But RA plans resulted in a reduced low-level dose bath (15-20 Gy) in the range of 14-16% compared with IMRT plans. The average MU needed to deliver the prescribed dose by RA technique was reduced by 20-25% compared with IMRT technique. The preliminary study on RA for esophageal cancers showed improvements in sparing OAR and healthy tissue with reduced beam-on time, whereas only double-arc RA offered improved target coverage compared with IMRT and 3D-CRT plans.

Vivekanandan, Nagarajan, E-mail: viveknaren@hotmail.com [Department of Medical Physics, Cancer Institute, Chennai (India); Sriram, Padmanaban; Syam Kumar, S.A.; Bhuvaneswari, Narayanan; Saranya, Kamalakannan [Department of Medical Physics, Cancer Institute, Chennai (India)

2012-04-01

380

Silane surface modification for improved bioadhesion of esophageal stents  

NASA Astrophysics Data System (ADS)

Stent migration occurs in 10-40% of patients who undergo placement of esophageal stents, with higher migration rates seen in those treated for benign esophageal disorders. This remains a major drawback of esophageal stent therapy. In this paper, we propose a new surface modification method to increase the adhesion between self-expandable metallic stents (SEMS) and tissue while preserving their removability. Taking advantage of the well-known affinity between epoxide and amine terminated silane coupling agents with amine and carboxyl groups that are abundant in proteins and related molecules in the human body; we modified the surfaces of silicone coated esophageal SEMS with these adhesive self-assembled monolayers (SAMs). We utilized vapor phase silanization to modify the surfaces of different substrates including PDMS strips and SEMS, and measured the force required to slide these substrates on a tissue piece. Our results suggest that surface modification of esophageal SEMS via covalent attachment of protein-binding coupling agents improves adhesion to tissue and could offer a solution to reduce SEMS migration while preserving their removability.

Karakoy, Mert; Gultepe, Evin; Pandey, Shivendra; Khashab, Mouen A.; Gracias, David H.

2014-08-01

381

Esophageal stent fracture: case report and review of the literature.  

PubMed

Endoscopic esophageal stent placement is widely used in the treatment of a variety of benign and malignant esophageal conditions. Self expanding metal stents (SEMS) are associated with significantly reduced stent related mortality and morbidity compared to plastic stents for treatment of esophageal conditions; however they have known complications of stent migration, stent occlusion, tumor ingrowth, stricture formation, reflux, bleeding and perforation amongst others. A rare and infrequently reported complication of SEMS is stent fracture and subsequent migration of the broken pieces. There have only been a handful of published case reports describing this problem. In this report we describe a case of a spontaneously fractured nitinol esophageal SEMS, and review the available literature on the unusual occurrence of SEMS fracture placed for benign or malignant obstruction in the esophagus. SEMS fracture could be a potentially dangerous event and should be considered in a patient having recurrent dysphagia despite successful placement of an esophageal SEMS. It usually requires endoscopic therapy and may unfortunately require surgery for retrieval of a distally migrated fragment. Early recognition and prompt management may be able to prevent further problems. PMID:24627608

Khara, Harshit S; Diehl, David L; Gross, Seth A

2014-03-14

382

Esophageal stent fracture: Case report and review of the literature  

PubMed Central

Endoscopic esophageal stent placement is widely used in the treatment of a variety of benign and malignant esophageal conditions. Self expanding metal stents (SEMS) are associated with significantly reduced stent related mortality and morbidity compared to plastic stents for treatment of esophageal conditions; however they have known complications of stent migration, stent occlusion, tumor ingrowth, stricture formation, reflux, bleeding and perforation amongst others. A rare and infrequently reported complication of SEMS is stent fracture and subsequent migration of the broken pieces. There have only been a handful of published case reports describing this problem. In this report we describe a case of a spontaneously fractured nitinol esophageal SEMS, and review the available literature on the unusual occurrence of SEMS fracture placed for benign or malignant obstruction in the esophagus. SEMS fracture could be a potentially dangerous event and should be considered in a patient having recurrent dysphagia despite successful placement of an esophageal SEMS. It usually requires endoscopic therapy and may unfortunately require surgery for retrieval of a distally migrated fragment. Early recognition and prompt management may be able to prevent further problems. PMID:24627608

Khara, Harshit S; Diehl, David L; Gross, Seth A

2014-01-01

383

Usefulness of biodegradable stents constructed of poly-l -lactic acid monofi laments in patients with benign esophageal stenosis  

Microsoft Academic Search

AIM: To report 13 patients with benign esophageal stenosis treated with the biodegradable stent. METHODS: We developed a Ultraflex-type stent by knitting poly-l -lactic acid monofi laments. RESULTS: Two cases were esophageal stenosis caused by drinking of caustic liquid, 4 cases were due to surgical resection of esophageal cancers, and 7 cases were patients with esophageal cancer who received the

Yasuharu Saito; Toyohiko Tanaka; Akira Andoh; Hideki Minematsu; Kazunori Hat; Tomoyuki Tsujikawa; Norihisa Nitta; Kiyoshi Murat

384

[Fiberscopic obliteration of esophageal varices (author's transl)].  

PubMed

We are reporting our 2 years experience in the fiberscopic sclerotherapy of esophageal varices. 170 patients from 15-83 years of age were treated (61 females and 109 males), the majority being around 50 years of age. In 162 cases, the cause of the portal hypertension was cirrhosis of the liver and in 8 cases thrombosis of the splenic or portal vein. 47 patients were treated during acute bleeding, 101 in the interval, and 22 prophylactically. Using the modified intravascular technique, most varices could be sclerosed after a maximum of three treatments. In 83%, acute hemorrhages were stopped. The hospital mortality amounted to 30%, while in the interval group only it was 5%. None of the prophylactically treated patients died during their stay in hospital. The mortality after an average of 11.2 months amounted to 11.8%: The main cause was liver failure. Bleeding reoccurred in 11.2% and resulted in death in every fifth case. The most common complication, namely stenosis, arose in 16 cases and 4 of these necessitated dilation therapy. Esophagothoracic fistulae occurred in 2 cases and could be cured by siphon drainage. The rate of complication amounted to 10.6%, without any lethal outcome. PMID:7453411

Soehendra, N; Kempeneers, I; Eichfuss, H P; Bützow, G H; von Braun, H H

1980-01-01

385

Fluoroscopic findings post-peroral esophageal myotomy.  

PubMed

Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that has been evolving rapidly. Endoscopic submucosal dissection was initiated in 1999, in Japan, for en-bloc resection of large lesions of the stomach (Zhou et al., World J Gastroenterol 19:6962-6968, 2013, ; Kobara et al., Clin Exp Gastroenterol 7:67-74, 2014). Since then, many additional therapies utilizing natural transluminal endoscopic approach have evolved. Peroral endoscopic myotomy (POEM) is a minimally invasive type of transluminal endoscopic surgery that was recently developed for the treatment of achalasia and esophageal motility disorders. The peroral endoscopic myotomy is a less invasive surgical treatment that is suitable for all types of achalasia and used as an alternate to the Heller myotomy. The radiographic findings of achalasia and surgical changes after Heller myotomy have been described, however, very little is available on the post-POEM esophagram appearance. The purpose of this article is to illustrate the anatomy, surgical procedure, and normal and abnormal findings seen on esophagrams in patients who have undergone a POEM. PMID:25128214

Harmath, Carla; Horowitz, Jeanne; Berggruen, Senta; Hammond, Nancy; Nikolaidis, Paul; Miller, Frank; Goodhartz, Lori; Teitlebaum, Erza; Hungness, Eric; Yaghmai, Vahid

2015-02-01

386

Polyglycolic acid sheet application to prevent esophageal stricture after endoscopic submucosal dissection for esophageal squamous cell carcinoma.  

PubMed

Background and study aim: Esophageal stricture following endoscopic submucosal dissection (ESD) can be a serious complication in patients with large mucosal defects. This preliminary study examined the efficacy of using a polyglycolic acid (PGA) sheet with fibrin glue for the prevention of esophageal stricture after ESD. Patients and methods: A total of 15 patients were enrolled. After resection, PGA sheets were placed over the surgical wound. The size of the mucosal defect was estimated by dividing the circumference of the esophagus into 12 parts of equal size. The occurrence of esophageal stricture at 6 weeks, along with the proportion of patients who had PGA sheet remaining in place 1 week and 2 weeks after ESD, and the occurrence of adverse events were investigated. Results: The size of mucosal defects in the 15 patients were 7/12 (n?=?4), 8?/12 (n?=?5), 9/12 (n?=?4), 10/12 (n?=?1) and 11/12 (n?=?1). Esophageal stricture occurred in 1/13 patients (7.7?%; two patients were not included in the analysis because they had required surgical resection during the follow-up period). The PGA sheet remained at 1 week after ESD in 13/15 patients (86.7?%) and at 2 weeks after ESD in 6/15 patients (40?%). No adverse events were observed. Conclusion: PGA sheets may have the potential to prevent esophageal stricture. PMID:25412087

Iizuka, Toshiro; Kikuchi, Daisuke; Yamada, Akihiro; Hoteya, Shu; Kajiyama, Yoshiaki; Kaise, Mitsuru

2014-11-20

387

Endothelial-mesenchymal transition in normal human esophageal endothelial cells cocultured with esophageal adenocarcinoma cells: role of IL-1? and TGF-?2.  

PubMed

Endothelial-mesenchymal transition (EndoMT) has been recognized as a key determinant of tumor microenvironment in cancer progression and metastasis. Endothelial cells undergoing EndoMT lose their endothelial markers, acquire the mesenchymal phenotype, and become more invasive with increased migratory abilities. Early stages of esophageal adenocarcinoma (EAC) are characterized by strong microvasculature whose impact in tumor progression remains undefined. Our aim was to determine the role of EndoMT in EAC by investigating the impact of tumor cells on normal primary human esophageal microvascular endothelial cells (HEMEC). HEMEC were either cocultured with OE33 adenocarcinoma cells or treated with IL-1? and transforming growth factor-?2 (TGF-?2) for indicated periods and analyzed for EndoMT-associated changes by real-time PCR, Western blotting, immunofluorescence staining, and functional assays. Additionally, human EAC tissues were investigated for detection of EndoMT-like cells. Our results demonstrate an increased expression of mesenchymal markers [fibroblast-specific protein 1 (FSP1), collagen1?2, vimentin, ?-smooth muscle actin (?-SMA), and Snail], decreased expression of endothelial markers [CD31, von Willebrand factor VIII (vWF), and VE-cadherin], and elevated migration ability in HEMEC following coculture with OE33 cells. The EndoMT-related changes were inhibited by IL-1? and TGF-?2 gene silencing in OE33 cells. Recombinant IL-1? and TGF-?2 induced EndoMT in HEMEC. Although the level of VEGF expression was elevated in EndoMT cells, the angiogenic property of these cells was diminished. In vivo, by immunostaining EndoMT-like cells were detected at the invasive front of EAC. Our findings underscore a significant role for EndoMT in EAC and provide new insights into the mechanisms and significance of EndoMT in the context of tumor progression. PMID:25163519

Nie, Linghui; Lyros, Orestis; Medda, Rituparna; Jovanovic, Nebojsa; Schmidt, Jamie L; Otterson, Mary F; Johnson, Christopher P; Behmaram, Behnaz; Shaker, Reza; Rafiee, Parvaneh

2014-11-01

388

Advances in the evaluation and management of esophageal disease of systemic sclerosis.  

PubMed

Symptoms of heartburn and dysphagia as well as objective findings of abnormal esophageal acid exposure and esophageal dysmotility are common in patients with systemic sclerosis (SSc). Treatments for SSc esophageal disease are generally limited to gastroesophageal reflux disease (GERD) treatment with proton pump inhibitors. Progresses made in esophageal diagnostic testing offer the potential for improved clinical characterization of esophageal disease in SSc that may help direct management decisions. In addition to reviewing GERD management in patients with SSc, present and potential uses of endoscopy, reflux monitoring, manometry, impedance planimetry, and endoscopic ultrasound are discussed. PMID:25475597

Carlson, Dustin A; Hinchcliff, Monique; Pandolfino, John E

2015-01-01

389

Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment.  

PubMed

Esophageal perforation due to transesophageal echocardiogram (TEE) during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC(®) clip (Ovesco Endoscopy, Tübingen, Germany). The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip. PMID:25120414

Robotis, John; Karabinis, Andreas

2014-05-01

390

[Differencial diagnosis of gastroesophageal reflux disease -- eosinophilic esophagitis: case report].  

PubMed

We report on a 22-year-old man with dysphagia and repeated bolus impaction in the esophagus for 10 years. Bolus impactions were frequently mobilised using an endoscope. At endoscopy, esophagitis IV degrees was described. After treatment with omeprazol there was no improvement. The patient was submitted to our hospital for fundoplication. pH-metry demonstrated an increased reflux. At endoscopy of the esophagus, we found red stripes which did not show the typical appearance of erosions. Manometry and X-ray films of the esophagus did not reveal any pathological findings. In combination with anamnesis, symptoms, and endoscopy, the diagnosis of eosinophilic esophagitis was documented by histology. After administration of oral corticosteroids a rapid improvement of the clinical symptoms was observed. The diagnosis of eosinophilic esophagitis should be kept in mind in patients with chronic symptoms of gastroesophageal reflux persisting despite medical therapy, pathological pH-metry and repeated bolus impactions. PMID:15830305

Franzius, M; Stolte, M; Porschen, R

2005-04-01

391

Type II congenital pulmonary airway malformation in an esophageal lung  

PubMed Central

A seven-month-old girl, born prematurely (birth weight 1000 g) from a twin pregnancy, was admitted to hospital due to recurrent pneumonia and atelectasis. She experienced cough and respiratory distress during feeding. The right hemithorax was smaller than the left, with diminished breath sounds and dullness. Chest x-rays revealed decreased lung volume and multiple radiolucent images in the right lung, as well as overdistention of the left lung. An esophagogram revealed three bronchial branches arising from the lower one-third of the esophagus, corresponding to the right lung and ending in a cul-de-sac. A diagnosis of esophageal lung was established. On bronchography, the right lung was absent and the trachea only continued into the left main bronchus. Echocardiography and angiotomography revealed agenesis of the pulmonary artery right branch. The surgical finding was an esophageal right lung, which was removed; the histopathological diagnosis was type II congenital pulmonary airway malformation in an esophageal lung. PMID:23762890

Martínez-Martínez, Blanca Estela; Furuya, María Elena Yuriko; Martínez-Muñiz, Irma; Vargas, Mario H; Flores-Salgado, Rosalinda

2013-01-01

392

Esophageal stent migration can lead to intestinal obstruction  

PubMed Central

Background: Self-expanding metallic stents are the devices of choice in the treatment of malign or benign strictures of the esophagus. Stent migration is a well-known complication of this procedure. Aims: We report a case of intestinal obstruction caused by esophageal stent migration, in which surgical intervention was used. Methods: A 65-year-old woman, who had a medical history of gastric cancer operations and esophageal stent applications, was admitted to our emergency department with a 48-hour history of abdominal pain, nausea and vomiting. An emergency laparotomy was performed and the migrated stent causing intestinal obstruction was removed. Results: The patient recovered without incident and was discharged on postoperative day 3. Conclusion: This case illustrates that esophageal stent migration has to be considered as a potential life-threatening complication. PMID:22666672

Karatepe, Oguzhan; Acet, Ersin; Altiok, Merih; Battal, Muharrem; Adas, Gokhan; Karahan, Servet

2009-01-01

393

Omental herniation through the esophageal hiatus mimics mediastinal lipomatous tumor.  

PubMed

A 61-year-old man with a mediastinal abnormal mass on computed tomography is presented. Sagittal sections of magnetic resonance imaging (MRI) clearly indicated the continuity of the fatty mass from the abdomen to the thorax. The diagnosis was an omental herniation through the esophageal hiatus during the operation. First, we returned the omentum into the abdominal cavity, and then repaired the hiatus. The patient had an uneventful postoperative recovery. A herniation of the omentum through the esophageal hiatus is rare; this case is the tenth found in both English and Japanese literatures. The coronal and sagittal planes of MRI were useful in distinguishing the herniation of omentum through the esophageal hiatus from lipomatous tumor. It is our intention of raising awareness about the disease. PMID:15651406

Yunoki, Junji; Ohteki, Hitoshi; Naito, Kozo; Hisajima, Kazuhiro

2004-12-01

394

Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment  

PubMed Central

Esophageal perforation due to transesophageal echocardiogram (TEE) during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC® clip (Ovesco Endoscopy, Tübingen, Germany). The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip. PMID:25120414

Robotis, John; Karabinis, Andreas

2014-01-01

395

Effect of pantoprazole in older patients with erosive esophagitis.  

PubMed

Several studies suggest that older adults with gastroesophageal reflux disease (GERD) are more likely to develop complications, including erosive esophagitis, but it is unclear whether erosive esophagitis is more difficult to treat in older patients. The purpose of this study was to determine if adults > or = 65 years with erosive esophagitis are more difficult to treat than younger adults. The study was a post hoc analysis of two double-blind, randomized, multicenter trials of patients with erosive esophagitis. Patients received pantoprazole 40 mg once daily, nizatidine 150 mg twice daily or placebo. Patients were evaluated for endoscopic healing at 4 and 8 weeks. Patients recorded typical reflux symptoms using a daily diary to note presence or absence of symptoms. Results showed that 44, 13 and 11 patients > or = 65 years and 210, 69, and 71 patients < 65 received pantoprazole 40 mg daily, nizatidine 150 mg twice daily, or placebo, respectively. Eighty-six percent (86%[76%, 97% CI]) of older and 83% (78%, 88% CI) of younger pantoprazole-treated patients were healed at 8 weeks; 46% (19%, 73% CI) and 35% (24%, 46% CI) of nizatidine-treated and 27% (1%, 54% CI) and 34% (23%, 45% CI) of placebo-treated were healed at 8 weeks. Median time to persistent absence of GERD-related symptoms was similar for older and younger patients treated with pantoprazole. We conclude that older patients with erosive esophagitis do not appear to have more difficult-to-treat disease. Erosive esophagitis is effectively healed and GERD symptoms are controlled in older patients using pantoprazole 40 mg daily. PMID:17760655

DeVault, K R; Morgenstern, D M; Lynn, R B; Metz, D C

2007-01-01

396

A Phase II Study of a Paclitaxel-Based Chemoradiation Regimen With Selective Surgical Salvage for Resectable Locoregionally Advanced Esophageal Cancer: Initial Reporting of RTOG 0246  

SciTech Connect

Purpose: The strategy of definitive chemoradiation with selective surgical salvage in locoregionally advanced esophageal cancer was evaluated in a Phase II trial in Radiation Therapy Oncology Group (RTOG)-affiliated sites. Methods and Materials: The study was designed to detect an improvement in 1-year survival from 60% to 77.5% ({alpha} = 0.05; power = 80%). Definitive chemoradiation involved induction chemotherapy with 5-fluorouracil (5-FU) (650 mg/mg{sup 2}/day), cisplatin (15 mg/mg{sup 2}/day), and paclitaxel (200 mg/mg{sup 2}/day) for two cycles, followed by concurrent chemoradiation with 50.4 Gy (1.8 Gy/fraction) and daily 5-FU (300 mg/mg{sup 2}/day) with cisplatin (15 mg/mg{sup 2}/day) over the first 5 days. Salvage surgical resection was considered for patients with residual or recurrent esophageal cancer who did not have systemic disease. Results: Forty-three patients with nonmetastatic resectable esophageal cancer were entered from Sept 2003 to March 2006. Forty-one patients were eligible for analysis. Clinical stage was {>=}T3 in 31 patients (76%) and N1 in 29 patients (71%), with adenocarcinoma histology in 30 patients (73%). Thirty-seven patients (90%) completed induction chemotherapy followed by concurrent chemoradiation. Twenty-eight patients (68%) experienced Grade 3+ nonhematologic toxicity. Four treatment-related deaths were noted. Twenty-one patients underwent surgery following definitive chemoradiation because of residual (17 patients) or recurrent (3 patients) esophageal cancer,and 1 patient because of choice. Median follow-up of live patients was 22 months, with an estimated 1-year survival of 71%. Conclusions: In this Phase II trial (RTOG 0246) evaluating selective surgical salvage after definitive chemoradiation in locoregionally advanced esophageal cancer, the hypothesized 1-year RTOG survival rate (77.5%) was not achieved (1 year, 71%; 95% confidence interval< 54%-82%).

Swisher, Stephen G., E-mail: sswisher@mdanderson.org [Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Winter, Kathryn A. [Headquarters, Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Komaki, Ritsuko U. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Wu, Tsung T. [Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (United States); Hofstetter, Wayne L. [Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Konski, Andre A. [Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Willett, Christopher G. [Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

2012-04-01

397

Outcome of Esophageal Function and 24-hour Esophageal pH Monitoring after Vertical Banded Gastroplasty and Roux-en-Y Gastric Bypass  

Microsoft Academic Search

Background: One of the co-morbidities frequently associated with morbid obesity is gastro-esophageal reflux disease (GERD),\\u000a present in >50 % of morbidly obese individuals. We compared the anti-reflux effect of vertical banded gastroplasty (VBG) and\\u000a Roux-en-Y gastric bypass (RYGBP), and their effect on esophageal function. Methods: 10 patients underwent VBG and 40 patients\\u000a underwent RYGBP. Anthropometric parameters, symptomatology of GERD, esophageal

Joaquin Ortega; Maria Dolores Escudero; Francisco Mora; Carlos Sala; Blas Flor; Jose Martinez-Valls; Vicente Sanchiz; Nieves Martinez-Alzamora; Adolfo Benages; Salvador Lledo

2004-01-01

398

Molecular Pathways: Pathogenesis and clinical implications of microbiome alteration in esophagitis and Barrett’s esophagus  

PubMed Central

Esophageal adenocarcinoma is preceded by the development of reflux-related intestinal metaplasia or Barrett’s esophagus which is a response to inflammation of the esophageal squamous mucosa, reflux esophagitis. Gastroesophageal reflux impairs the mucosal barrier in the distal esophagus, allowing chronic exposure of the squamous epithelium to the diverse microbial ecosystem or microbiome, and inducing chronic inflammation. The esophageal microbiome is altered in both esophagitis and Barrett's esophagus, characterized by a significant decrease in Gram-positive bacteria and an increase in Gram-negative bacteria in esophagitis and Barrett's esophagus. Lipopolysaccharides (LPS), a major structure of the outer membrane in Gram-negative bacteria, can up-regulate gene expression of proinflammatory cytokines via activation of the TLR4 and NF-kB pathway. The potential impact of LPS on reflux esophagitis may be through relaxation of the lower esophageal sphincter via iNOS and by delaying gastric emptying via COX-2. Chronic inflammation may be play a critical role in the progression from benign to malignant esophageal disease. Therefore analysis of the pathways leading to chronic inflammation in the esophagus may help to identify biomarkers in Barrett's esophagus patients for neoplastic progression and provide insight into molecular events suitable for therapeutic intervention in prevention of esophageal adenocarcinoma development in patients with reflux esophagitis and Barrett's esophagus. PMID:22344232

Yang, Liying; Francois, Fritz; Pei, Zhiheng

2013-01-01

399

Hospital type- and volume-outcome relationships in esophageal cancer patients receiving non-surgical treatments  

PubMed Central

AIM: To study the “hospital type-outcome” and “volume-outcome” relationships in patients with esophageal cancer who receive non-surgical treatments. METHODS: A total of 6106 patients with esophageal cancer diagnosed between 2008 and 2011 were identified from a national population-based cancer registry in Taiwan. The hospital types were defined as medical center and non-medical center. The threshold for high-volume hospitals was based on a median volume of 225 cases between 2008 and 2011 (annual volume, > 56 cases) or an upper quartile (> 75%) volume of 377 cases (annual volume > 94 cases). Cox regression analyses were used to determine the effects of hospital type and volume outcome on patient survival. RESULTS: A total of 3955 non-surgically treated patients were included in the survival analysis. In the unadjusted analysis, the significant prognostic factors included cT, cN, cM stage, hospital type and hospital volume (annual volume, > 94 vs ? 94). The 1- and 3-year overall survival rates in the non-medical centers (36.2% and 13.2%, respectively) were significantly higher than those in the medical centers (33.5% and 11.3%, respectively; P = 0.027). The 1- and 3-year overall survival rates in hospitals with an annual volume of ? 94 (35.3% and 12.6%, respectively) were significantly higher than those with an annual volume of > 94 (31.1% and 9.4%, respectively; P = 0.001). However, in the multivariate analysis, the hospital type was not statistically significant. Only cT, cN, and cM stages and hospital volume (annual volume > 94 vs ? 94) were independent prognostic factors. CONCLUSION: Whether the treatment occurs in medical centers is not a significant prognostic factor. High-volume hospitals were not associated with better survival rates compared with low-volume hospitals.

Hsu, Po-Kuei; Chen, Hui-Shan; Wang, Bing-Yen; Wu, Shiao-Chi; Liu, Chao-Yu; Shih, Chih-Hsun; Liu, Chia-Chuan

2015-01-01

400

Pulmonary Embolism in a Patient with Eosinophilic Esophagitis: Causal or Coincidental?  

PubMed Central

Eosinophilic esophagitis is a chronic immune-mediated disease characterized by infiltration of the esophageal mucosa with eosinophils and concomitant esophageal dysfunction. Though there are well-described associations between certain chronic inflammatory conditions and venous thromboembolism, there have been no reports of venous thromboembolism occurring in eosinophilic esophagitis. We report the case of a 33-year-old man with severe eosinophilic esophagitis resulting in recurrent esophageal strictures who was unresponsive to oral viscous budesonide therapy, and who developed an isolated pulmonary embolism in the absence of risk factors for venous thromboembolism. We then discuss potential mechanisms for venous thromboembolism in eosinophilic esophagitis, such as inflammation-mediated hypercoagulability, hypereosinophilia, and immunoglobulin E-mediated platelet activation. PMID:23626508

Jones, Patricia D.; Moll, Stephan; Dellon, Evan S.

2013-01-01

401

Thoracoscopic stapled resection of multiple esophageal duplication cysts with different pathological findings.  

PubMed

Esophageal duplication cyst is a rare congenital esophageal anomaly of the foregut. This cyst usually occurs in isolation, and thus far, was treated by enucleation through thoracoscopic or thoracotomic surgery. Here we report a case of multiple esophageal duplication cysts that showed different pathological findings, i.e., the cysts were lined with pseudostratified ciliated columnar and stratified squamous epithelium. Esophageal cysts were incidentally detected in a 53-year-old man during the treatment of pneumonia. In chest-computed tomography, the cysts showed a thin wall and homogeneous inner density, while in endoscopy, no communication with esophageal mucosa was observed. We resected the esophageal cysts with endo-staplers under thoracoscopic surgery. No postoperative complications, including esophageal mucosal injury, occurred. A follow-up chest computed tomography revealed the complete resection of the cysts. PMID:18486485

Kang, Chul Ung; Cho, Deog Gon; Cho, Kyu Do; Jo, Min Seop

2008-07-01

402

Chronic Cough and Eosinophilic Esophagitis: An Uncommon Association  

PubMed Central

An increasing number of children, usually with gastrointestinal symptoms, is diagnosed with eosinophilic esophagitis (EE), and a particular subset of these patients complains of airway manifestations. We present the case of a 2-year-old child with chronic dry cough in whom EE was found after a first diagnosis of gastroesophageal reflux disease (GERD) due to pathological 24-hour esophageal pH monitoring. Traditional allergologic tests were negative, while patch tests were diagnostic for cow's milk allergy. We discuss the intriguing relationship between GERD and EE and the use of patch test for the allergologic screening of patients. PMID:21960955

Orizio, Paolo; Cinquini, Massimo; Minetti, Stefano; Alberti, Daniele; Paolo, Camilla Di; Villanacci, Vincenzo; Torri, Fabio; Crispino, Paola; Facchetti, Susanna; Rizzini, Fabio Lodi; Bassotti, Gabrio; Tosoni, Cinzia

2011-01-01

403

Omental herniation through the esophageal hiatus in a cat.  

PubMed

A four-year-old male cat was presented with regurgitation. Thoracic radiography and contrast radiogram showed a large oval mass and elevated esophagus. Exploratory thoracotomy showed omental herniation into the posterior mediastium through the esophageal hiatus. Because the mass of the omental herniation was so large, celiotomy through a paracostal incision was combined in order to return the omentum to its normal position. The diameter of the esophageal hiatus was approximately 1 cm but no fibrous adhesion was observed around the hiatus. Continuous 1-0 surgical sutures on the hiatus reduced the diameter of the hiatus. The cat made a successful postoperative recovery without complications. PMID:12520113

Mitsuoka, Kokori; Tanaka, Ryou; Nagashima, Yukiko; Hoshi, Katsuichiro; Matsumoto, Hirokazu; Yamane, Yoshihisa

2002-12-01

404

Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial)  

PubMed Central

Background For esophageal cancer patients, radical esophagolymphadenectomy is the cornerstone of multimodality treatment with curative intent. Transthoracic esophagectomy is the preferred surgical approach worldwide allowing for en-bloc resection of the tumor with the surrounding lymph nodes. However, the percentage of cardiopulmonary complications associated with the transthoracic approach is high (50 to 70%). Recent studies have shown that robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RATE) is at least equivalent to the open transthoracic approach for esophageal cancer in terms of short-term oncological outcomes. RATE was accompanied with reduced blood loss, shorter ICU stay and improved lymph node retrieval compared with open esophagectomy, and the pulmonary complication rate, hospital stay and perioperative mortality were comparable. The objective is to evaluate the efficacy, risks, quality of life and cost-effectiveness of RATE as an alternative to open transthoracic esophagectomy for treatment of esophageal cancer. Methods/design This is an investigator-initiated and investigator-driven monocenter randomized controlled parallel-group, superiority trial. All adult patients (age ?18 and ?80 years) with histologically proven, surgically resectable (cT1-4a, N0-3, M0) esophageal carcinoma of the intrathoracic esophagus and with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n = 112) with resectable esophageal cancer are randomized in the outpatient department to either RATE (n = 56) or open three-stage transthoracic esophageal resection (n = 56). The primary outcome of this study is the percentage of overall complications (grade 2 and higher) as stated by the modified Clavien–Dindo classification of surgical complications. Discussion This is the first randomized controlled trial designed to compare RATE with open transthoracic esophagectomy as surgical treatment for resectable esophageal cancer. If our hypothesis is proven correct, RATE will result in a lower percentage of postoperative complications, lower blood loss, and shorter hospital stay, but with at least similar oncologic outcomes and better postoperative quality of life compared with open transthoracic esophagectomy. The study started in January 2012. Follow-up will be 5 years. Short-term results will be analyzed and published after discharge of the last randomized patient. Trial registration Dutch trial register: NTR3291 ClinicalTrial.gov: NCT01544790 PMID:23199187

2012-01-01

405

Prognostic Value of Metabolic Tumor Volume Measured by 18F-FDG PET/CT in Esophageal Cancer Patients  

PubMed Central

Objective: In this study, we aimed to explore prognostic importance of definition of preoperative metabolic tumor volume in esophageal cancer patients. Methods: 22 patients who have histologically proven stage IIA-III esophageal cancer and underwent 18F-FDG PET/CT for preoperative staging of disease were included to the study. After 18F-FDG PET/CT, all the patients underwent surgery within 4 weeks period. Patients have been followed up until death or Sept 15th, 2012. Dates of death were recorded for survival analysis. During evaluation of 18F-FDG PET/CT images, metabolic tumor volumes were calculated by drawing the isocontour region of interests from all visually positive FGD uptake lesions. Results: 22 patients (15M, 7F; mean age: 65.1±8.4, min-max:48-80) underwent 18F-FDG PET/CT for preoperative staging of esophageal cancer. Preoperative diagnosis was squamous cell and adeno cancer in 17 (%77) and 5 (%23) patients, respectively. Location of primary tumor is distal, proximal and mid-esophagus in 13 (%59), 6 (%27) and 3 (%13) patients, respectively. Primary tumor of all the patients were FDG avid (mean SUVmax: 18.85±7.0; range: 5.5-35.1). Additionally, 18F-FDG upt